Provider Demographics
NPI:1437866316
Name:SIMMONS FAMILY HOME CARE LLC
Entity Type:Organization
Organization Name:SIMMONS FAMILY HOME CARE LLC
Other - Org Name:SIMMONS FAMILY HOME CARE LLC
Other - Org Type:Former Legal Business Name
Authorized Official - Title/Position:OWENER
Authorized Official - Prefix:
Authorized Official - First Name:LORENZO
Authorized Official - Middle Name:DAJUAN
Authorized Official - Last Name:SIMMONS
Authorized Official - Suffix:I
Authorized Official - Credentials:HEALTH AID
Authorized Official - Phone:419-917-8000
Mailing Address - Street 1:2955 DALEFORD DR
Mailing Address - Street 2:
Mailing Address - City:TOLEDO
Mailing Address - State:OH
Mailing Address - Zip Code:43614-5451
Mailing Address - Country:US
Mailing Address - Phone:419-917-8000
Mailing Address - Fax:
Practice Address - Street 1:2955 DALEFORD DR
Practice Address - Street 2:
Practice Address - City:TOLEDO
Practice Address - State:OH
Practice Address - Zip Code:43614-5451
Practice Address - Country:US
Practice Address - Phone:419-917-8000
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2022-11-01
Last Update Date:2022-11-04
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes374U00000XNursing Service Related ProvidersHome Health AideGroup - Multi-Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
OH4199178000Medicaid