Provider Demographics
NPI:1679662456
Name:AMERICARE HOME HEALTH AGENCY LLC
Entity Type:Organization
Organization Name:AMERICARE HOME HEALTH AGENCY LLC
Other - Org Name:AMERICARE HOME HEALTH AGENCY LLC
Other - Org Type:Former Legal Business Name
Authorized Official - Title/Position:AUTHORIZED OFFICIAL
Authorized Official - Prefix:
Authorized Official - First Name:KIMBERLY
Authorized Official - Middle Name:ANN
Authorized Official - Last Name:RANDOLPH
Authorized Official - Suffix:
Authorized Official - Credentials:LPN
Authorized Official - Phone:937-353-8575
Mailing Address - Street 1:1615 S ALEX RD
Mailing Address - Street 2:
Mailing Address - City:DAYTON
Mailing Address - State:OH
Mailing Address - Zip Code:45449-5406
Mailing Address - Country:US
Mailing Address - Phone:937-287-8395
Mailing Address - Fax:937-353-8357
Practice Address - Street 1:1615 S ALEX RD
Practice Address - Street 2:
Practice Address - City:DAYTON
Practice Address - State:OH
Practice Address - Zip Code:45449-5406
Practice Address - Country:US
Practice Address - Phone:937-287-8395
Practice Address - Fax:937-353-8357
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-10-12
Last Update Date:2024-03-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OH1563558251E00000X
OH251E00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes251E00000XAgenciesHome Health
Provider Identifiers
StateIdentifier IDID TypeIssuer
OH2683396Medicaid
OHOH03966OtherODH
OH2717886Medicaid
OHOH03966OtherODH #
OH2683396Medicaid