Provider Demographics
NPI:1679248843
Name:PROSPECT HOME HEALTH LLC
Entity Type:Organization
Organization Name:PROSPECT HOME HEALTH LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:CEO
Authorized Official - Prefix:
Authorized Official - First Name:IRENE
Authorized Official - Middle Name:MBENYA
Authorized Official - Last Name:KYAI
Authorized Official - Suffix:
Authorized Official - Credentials:RN
Authorized Official - Phone:614-834-3915
Mailing Address - Street 1:1515 BETHEL RD STE 302A
Mailing Address - Street 2:
Mailing Address - City:COLUMBUS
Mailing Address - State:OH
Mailing Address - Zip Code:43220-2056
Mailing Address - Country:US
Mailing Address - Phone:614-834-3915
Mailing Address - Fax:
Practice Address - Street 1:1515 BETHEL RD STE 302A
Practice Address - Street 2:
Practice Address - City:COLUMBUS
Practice Address - State:OH
Practice Address - Zip Code:43220-2056
Practice Address - Country:US
Practice Address - Phone:614-834-3915
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2021-08-10
Last Update Date:2021-08-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes251E00000XAgenciesHome Health
Provider Identifiers
StateIdentifier IDID TypeIssuer
OHRN415761OtherRN LICENSE NUMBER