Provider Demographics
NPI:1326413568
Name:MPQH HEALTHCARE PROFESSIONALS,LLC
Entity Type:Organization
Organization Name:MPQH HEALTHCARE PROFESSIONALS,LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:CEO/PRESIDENT/MEMBER
Authorized Official - Prefix:
Authorized Official - First Name:LYDIA
Authorized Official - Middle Name:
Authorized Official - Last Name:HARRIS
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:317-560-2809
Mailing Address - Street 1:2021 E DUBLIN GRANVILLE RD STE 175
Mailing Address - Street 2:
Mailing Address - City:COLUMBUS
Mailing Address - State:OH
Mailing Address - Zip Code:43229-3570
Mailing Address - Country:US
Mailing Address - Phone:614-468-1465
Mailing Address - Fax:614-420-2230
Practice Address - Street 1:2151 E DUBLIN GRANVILLE RD STE 219
Practice Address - Street 2:
Practice Address - City:COLUMBUS
Practice Address - State:OH
Practice Address - Zip Code:43229-3554
Practice Address - Country:US
Practice Address - Phone:317-560-2809
Practice Address - Fax:614-423-7875
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2015-12-13
Last Update Date:2018-05-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes251E00000XAgenciesHome Health