Provider Demographics
NPI:1568843712
Name:AMERICAN FAMILY HOME HEALTH AGENCY LLC
Entity Type:Organization
Organization Name:AMERICAN FAMILY HOME HEALTH AGENCY LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:
Authorized Official - First Name:JACQUELINE
Authorized Official - Middle Name:
Authorized Official - Last Name:REED
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:614-252-4651
Mailing Address - Street 1:620 ALUM CREEK DR
Mailing Address - Street 2:307
Mailing Address - City:COLUMBUS
Mailing Address - State:OH
Mailing Address - Zip Code:43205-1653
Mailing Address - Country:US
Mailing Address - Phone:614-252-4651
Mailing Address - Fax:888-511-0533
Practice Address - Street 1:620 ALUM CREEK DR
Practice Address - Street 2:307
Practice Address - City:COLUMBUS
Practice Address - State:OH
Practice Address - Zip Code:43205-1653
Practice Address - Country:US
Practice Address - Phone:614-252-4651
Practice Address - Fax:888-511-0533
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2015-06-13
Last Update Date:2015-06-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OH251E00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes251E00000XAgenciesHome Health
Provider Identifiers
StateIdentifier IDID TypeIssuer
OH3148285Medicaid