Provider Demographics
NPI:1417955170
Name:NATIONWIDE CHILDREN'S HOSPITAL HOMECARE
Entity Type:Organization
Organization Name:NATIONWIDE CHILDREN'S HOSPITAL HOMECARE
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:VP HOMECARE
Authorized Official - Prefix:
Authorized Official - First Name:WANDA
Authorized Official - Middle Name:
Authorized Official - Last Name:STACKPOLE
Authorized Official - Suffix:
Authorized Official - Credentials:RN
Authorized Official - Phone:614-355-1100
Mailing Address - Street 1:255 E MAIN ST
Mailing Address - Street 2:
Mailing Address - City:COLUMBUS
Mailing Address - State:OH
Mailing Address - Zip Code:43215-5222
Mailing Address - Country:US
Mailing Address - Phone:614-355-1100
Mailing Address - Fax:614-355-1182
Practice Address - Street 1:255 E MAIN ST
Practice Address - Street 2:
Practice Address - City:COLUMBUS
Practice Address - State:OH
Practice Address - Zip Code:43215-5222
Practice Address - Country:US
Practice Address - Phone:614-355-1100
Practice Address - Fax:614-355-1182
EIN:<UNAVAIL>
Is Organization Subpart?:Yes
Parent Organization LBN:NATIONWIDE CHILDREN'S HOSPITAL
Parent Organization TIN:<UNAVAIL>
Enumeration Date:2005-07-07
Last Update Date:2008-05-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
251E00000X
OHBC3288455251F00000X
OH0097-HSP251G00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes251E00000XAgenciesHome Health
No251F00000XAgenciesHome Infusion
No251G00000XAgenciesHospice Care, Community Based
Provider Identifiers
StateIdentifier IDID TypeIssuer
OH0842860Medicaid
OH0842860Medicaid
361587Medicare Oscar/Certification