Provider Demographics
NPI:1578742979
Name:MIKOUIS HOME DELIVERY HEALTHCARE, LLC
Entity Type:Organization
Organization Name:MIKOUIS HOME DELIVERY HEALTHCARE, LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:RN / CEO
Authorized Official - Prefix:MRS
Authorized Official - First Name:JEANNETTE
Authorized Official - Middle Name:
Authorized Official - Last Name:MIKOUIS
Authorized Official - Suffix:
Authorized Official - Credentials:RN, RD/LD, LNHA
Authorized Official - Phone:330-420-9826
Mailing Address - Street 1:PO BOX 487
Mailing Address - Street 2:840 N MARKET ST
Mailing Address - City:LISBON
Mailing Address - State:OH
Mailing Address - Zip Code:44432-0487
Mailing Address - Country:US
Mailing Address - Phone:330-420-9826
Mailing Address - Fax:330-420-9821
Practice Address - Street 1:840 N MARKET ST
Practice Address - Street 2:
Practice Address - City:LISBON
Practice Address - State:OH
Practice Address - Zip Code:44432-1022
Practice Address - Country:US
Practice Address - Phone:330-420-9826
Practice Address - Fax:330-420-9821
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-11-01
Last Update Date:2007-11-01
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OH251E00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes251E00000XAgenciesHome Health