Provider Demographics
NPI:1437495736
Name:CHI NATIONAL HOME CARE, LLC
Entity Type:Organization
Organization Name:CHI NATIONAL HOME CARE, LLC
Other - Org Name:CHI HEALTH AT HOME - GRAND ISLAND
Other - Org Type:Doing Business As
Authorized Official - Title/Position:V.P. FINANCE & CFO
Authorized Official - Prefix:
Authorized Official - First Name:JACK
Authorized Official - Middle Name:
Authorized Official - Last Name:HAWKINS
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:513-576-8478
Mailing Address - Street 1:6281 TRI RIDGE BLVD STE 300
Mailing Address - Street 2:
Mailing Address - City:LOVELAND
Mailing Address - State:OH
Mailing Address - Zip Code:45140-8345
Mailing Address - Country:US
Mailing Address - Phone:513-576-0262
Mailing Address - Fax:
Practice Address - Street 1:2116 W FAIDLEY AVE
Practice Address - Street 2:
Practice Address - City:GRAND ISLAND
Practice Address - State:NE
Practice Address - Zip Code:68803-4678
Practice Address - Country:US
Practice Address - Phone:308-398-2600
Practice Address - Fax:308-398-2633
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2012-12-14
Last Update Date:2022-12-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes251E00000XAgenciesHome Health
Provider Identifiers
StateIdentifier IDID TypeIssuer
NE10026348100Medicaid
28-7005OtherMEDICARE