Provider Demographics
NPI:1679749030
Name:MEDIC HOME HEALTH CARE, LLC
Entity Type:Organization
Organization Name:MEDIC HOME HEALTH CARE, LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:EXECUTIVE DIRECTOR
Authorized Official - Prefix:MR
Authorized Official - First Name:WILLIAM
Authorized Official - Middle Name:
Authorized Official - Last Name:COLLINS
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:440-449-7727
Mailing Address - Street 1:701 BETA DR
Mailing Address - Street 2:#7
Mailing Address - City:MAYFIELD VILLAGE
Mailing Address - State:OH
Mailing Address - Zip Code:44143-2367
Mailing Address - Country:US
Mailing Address - Phone:440-449-7727
Mailing Address - Fax:440-449-7725
Practice Address - Street 1:701 BETA DR
Practice Address - Street 2:#7
Practice Address - City:MAYFIELD VILLAGE
Practice Address - State:OH
Practice Address - Zip Code:44143-2367
Practice Address - Country:US
Practice Address - Phone:440-449-7727
Practice Address - Fax:440-449-7725
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2008-05-06
Last Update Date:2008-05-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OH02-0998700332BX2000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes332BX2000XSuppliersDurable Medical Equipment & Medical SuppliesOxygen Equipment & Supplies
Provider Identifiers
StateIdentifier IDID TypeIssuer
OH2788274Medicaid