Provider Demographics
NPI:1417137902
Name:1073 INVESTMENTS, LLC
Entity Type:Organization
Organization Name:1073 INVESTMENTS, LLC
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 1:11427 REED HARTMAN HWY
Mailing Address - Street 2:
Mailing Address - City:BLUE ASH
Mailing Address - State:OH
Mailing Address - Zip Code:45241-2418
Mailing Address - Country:US
Mailing Address - Phone:513-724-3325
Mailing Address - Fax:844-724-3325
Practice Address - Street 1:11427 REED HARTMAN HWY
Practice Address - Street 2:
Practice Address - City:BLUE ASH
Practice Address - State:OH
Practice Address - Zip Code:45241-2418
Practice Address - Country:US
Practice Address - Phone:513-724-3325
Practice Address - Fax:844-724-3325
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-11-13
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
OH3053341Medicaid
OH368228Medicare Oscar/Certification