Provider Demographics
NPI:1508881913
Name:OMNICARE HOME HEALTHCARE AGENCY, LLC
Entity Type:Organization
Organization Name:OMNICARE HOME HEALTHCARE AGENCY, LLC
Other - Org Name:OMNICARE HOME HEALTH AGENCY
Other - Org Type:Doing Business As
Authorized Official - Title/Position:PRESIDENT CEO
Authorized Official - Prefix:MR
Authorized Official - First Name:CHRISTIAN
Authorized Official - Middle Name:N
Authorized Official - Last Name:OCHEI
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:330-459-0398
Mailing Address - Street 1:1148 MORNING GLORY DR
Mailing Address - Street 2:
Mailing Address - City:MACEDONIA
Mailing Address - State:OH
Mailing Address - Zip Code:44056-4305
Mailing Address - Country:US
Mailing Address - Phone:330-459-0398
Mailing Address - Fax:330-748-4660
Practice Address - Street 1:23611 CHAGRIN BLVD STE 120
Practice Address - Street 2:
Practice Address - City:BEACHWOOD
Practice Address - State:OH
Practice Address - Zip Code:44122-5540
Practice Address - Country:US
Practice Address - Phone:216-292-6352
Practice Address - Fax:330-748-4660
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-07-13
Last Update Date:2024-03-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OH251E00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes251E00000XAgenciesHome Health
Provider Identifiers
StateIdentifier IDID TypeIssuer
OH40323953OtherODA PROVIDER NUMBER
OH2462839Medicaid
OH36-8049Medicare ID - Type UnspecifiedMEDICARE PROVIDER NUMBER