Provider Demographics
NPI:1275996936
Name:CAREPINE HOME HEALTH, LLC
Entity Type:Organization
Organization Name:CAREPINE HOME HEALTH, LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:CEO
Authorized Official - Prefix:
Authorized Official - First Name:ELIUD
Authorized Official - Middle Name:
Authorized Official - Last Name:OMOLLO
Authorized Official - Suffix:
Authorized Official - Credentials:MS
Authorized Official - Phone:570-234-0931
Mailing Address - Street 1:670 N. RIVER ST.
Mailing Address - Street 2:SUITE 401
Mailing Address - City:WILKES BARRE
Mailing Address - State:PA
Mailing Address - Zip Code:18705-1028
Mailing Address - Country:US
Mailing Address - Phone:570-234-0931
Mailing Address - Fax:
Practice Address - Street 1:7164 ROUTE 209 STE 410
Practice Address - Street 2:
Practice Address - City:STROUDSBURG
Practice Address - State:PA
Practice Address - Zip Code:18360-7108
Practice Address - Country:US
Practice Address - Phone:570-234-0931
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2016-03-31
Last Update Date:2022-05-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PA06190501251E00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes251E00000XAgenciesHome Health