Provider Demographics
NPI:1659638716
Name:KATYS HOME HEALTH CARE LLC
Entity Type:Organization
Organization Name:KATYS HOME HEALTH CARE LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OFFICE MANAGER
Authorized Official - Prefix:MRS
Authorized Official - First Name:KARI
Authorized Official - Middle Name:MARIE
Authorized Official - Last Name:PHILLIPS
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:937-763-1229
Mailing Address - Street 1:12140 WILMINGTON AVE.
Mailing Address - Street 2:
Mailing Address - City:HIGHLAND
Mailing Address - State:OH
Mailing Address - Zip Code:45132
Mailing Address - Country:US
Mailing Address - Phone:937-763-3843
Mailing Address - Fax:
Practice Address - Street 1:47 S FAIRFIELD ST
Practice Address - Street 2:
Practice Address - City:LEESBURG
Practice Address - State:OH
Practice Address - Zip Code:45135-0335
Practice Address - Country:US
Practice Address - Phone:937-780-7977
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2012-04-13
Last Update Date:2013-03-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OH2012390337251E00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes251E00000XAgenciesHome Health
Provider Identifiers
StateIdentifier IDID TypeIssuer
OH=========Medicaid