Provider Demographics
NPI:1699365171
Name:GRACIOUS HEARTS HOME HEALTHCARE OF OHIO LLC
Entity Type:Organization
Organization Name:GRACIOUS HEARTS HOME HEALTHCARE OF OHIO LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:MS
Authorized Official - First Name:VERONICA
Authorized Official - Middle Name:
Authorized Official - Last Name:REEVES
Authorized Official - Suffix:
Authorized Official - Credentials:LPN
Authorized Official - Phone:513-720-7500
Mailing Address - Street 1:3225 OAKLEY STATION BLVD UNIT 110
Mailing Address - Street 2:
Mailing Address - City:CINCINNATI
Mailing Address - State:OH
Mailing Address - Zip Code:45209-1277
Mailing Address - Country:US
Mailing Address - Phone:513-720-7500
Mailing Address - Fax:
Practice Address - Street 1:3225 OAKLEY STATION BLVD UNIT 110
Practice Address - Street 2:
Practice Address - City:CINCINNATI
Practice Address - State:OH
Practice Address - Zip Code:45209-1277
Practice Address - Country:US
Practice Address - Phone:513-720-7500
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2021-01-19
Last Update Date:2021-01-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes374U00000XNursing Service Related ProvidersHome Health AideGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
OH1184955619Medicaid