Provider Demographics
NPI:1437648953
Name:HOME STATE HEALTHCARE, INC
Entity Type:Organization
Organization Name:HOME STATE HEALTHCARE, INC
Other - Org Name:HOME STATE HEALTHCARE
Other - Org Type:Doing Business As
Authorized Official - Title/Position:CEO
Authorized Official - Prefix:
Authorized Official - First Name:LISA
Authorized Official - Middle Name:
Authorized Official - Last Name:BROOMHALL
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:937-335-2689
Mailing Address - Street 1:410 W MAIN ST
Mailing Address - Street 2:
Mailing Address - City:TROY
Mailing Address - State:OH
Mailing Address - Zip Code:45373-3244
Mailing Address - Country:US
Mailing Address - Phone:937-335-2689
Mailing Address - Fax:937-835-6223
Practice Address - Street 1:410 W MAIN ST
Practice Address - Street 2:
Practice Address - City:TROY
Practice Address - State:OH
Practice Address - Zip Code:45373-3244
Practice Address - Country:US
Practice Address - Phone:937-335-2689
Practice Address - Fax:937-835-6223
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2018-05-10
Last Update Date:2018-05-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes251E00000XAgenciesHome Health
Provider Identifiers
StateIdentifier IDID TypeIssuer
OH0165372Medicaid