Provider Demographics
NPI:1316031776
Name:STATNURSE HOME HEALTH INC.
Entity Type:Organization
Organization Name:STATNURSE HOME HEALTH INC.
Other - Org Name:IDEAL HOME HEALTH CARE
Other - Org Type:Doing Business As
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:
Authorized Official - First Name:JOHN
Authorized Official - Middle Name:
Authorized Official - Last Name:ROSE
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:937-830-3544
Mailing Address - Street 1:5524 HILLIARD ROME OFFICE PARK
Mailing Address - Street 2:
Mailing Address - City:HILLIARD
Mailing Address - State:OH
Mailing Address - Zip Code:43026-7286
Mailing Address - Country:US
Mailing Address - Phone:614-464-3325
Mailing Address - Fax:844-724-3325
Practice Address - Street 1:5524 HILLIARD ROME OFFICE PARK
Practice Address - Street 2:
Practice Address - City:HILLIARD
Practice Address - State:OH
Practice Address - Zip Code:43026-7286
Practice Address - Country:US
Practice Address - Phone:614-464-3325
Practice Address - Fax:844-724-3325
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-10-02
Last Update Date:2014-06-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OH251E00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes251E00000XAgenciesHome Health
Provider Identifiers
StateIdentifier IDID TypeIssuer
OH2727768Medicaid
OH368167Medicare Oscar/Certification