Provider Demographics
NPI:1639672025
Name:PRINCIPAL HOME HEALTH CARE SERVICES
Entity Type:Organization
Organization Name:PRINCIPAL HOME HEALTH CARE SERVICES
Other - Org Name:PH HEALTH CARE
Other - Org Type:Doing Business As
Authorized Official - Title/Position:CEO/CARE COORDINATOR
Authorized Official - Prefix:
Authorized Official - First Name:JERRY
Authorized Official - Middle Name:BICHUA
Authorized Official - Last Name:NANDI
Authorized Official - Suffix:
Authorized Official - Credentials:RN, MPH
Authorized Official - Phone:216-312-2275
Mailing Address - Street 1:17068 HUNTING MEADOWS DR
Mailing Address - Street 2:
Mailing Address - City:STRONGSVILLE
Mailing Address - State:OH
Mailing Address - Zip Code:44136-6267
Mailing Address - Country:US
Mailing Address - Phone:216-312-2275
Mailing Address - Fax:
Practice Address - Street 1:17068 HUNTING MEADOWS DR
Practice Address - Street 2:
Practice Address - City:STRONGSVILLE
Practice Address - State:OH
Practice Address - Zip Code:44136-6267
Practice Address - Country:US
Practice Address - Phone:216-312-2275
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2018-03-13
Last Update Date:2018-03-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OH375296163WH0200X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes163WH0200XNursing Service ProvidersRegistered NurseHome HealthGroup - Multi-Specialty