Provider Demographics
NPI:1609097443
Name:PURE HEALTH AT HOME LLC
Entity Type:Organization
Organization Name:PURE HEALTH AT HOME LLC
Other - Org Name:SEASONS OF CARE HEALTH SERVICES LLC
Other - Org Type:Former Legal Business Name
Authorized Official - Title/Position:VICE PRESIDENT OF CARE AND HOUSING
Authorized Official - Prefix:
Authorized Official - First Name:DANIEL
Authorized Official - Middle Name:
Authorized Official - Last Name:FAGAN
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:614-395-6233
Mailing Address - Street 1:8000 RAVINES EDGE COURT
Mailing Address - Street 2:SUITE 102
Mailing Address - City:COLUMBUS
Mailing Address - State:OH
Mailing Address - Zip Code:43235
Mailing Address - Country:US
Mailing Address - Phone:833-444-4177
Mailing Address - Fax:833-263-0944
Practice Address - Street 1:4255 CENTER RD.
Practice Address - Street 2:2ND FLOOR WELLNESS CENTER
Practice Address - City:BRUNSWICK
Practice Address - State:OH
Practice Address - Zip Code:44212
Practice Address - Country:US
Practice Address - Phone:833-444-4177
Practice Address - Fax:833-263-0944
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-05-01
Last Update Date:2023-12-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OH368025251E00000X
251E00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes251E00000XAgenciesHome Health
Provider Identifiers
StateIdentifier IDID TypeIssuer
OH368025Medicare Oscar/Certification