Provider Demographics
NPI:1760415442
Name:HEALTH CARE DEPO OF OHIO LLC
Entity Type:Organization
Organization Name:HEALTH CARE DEPO OF OHIO LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:CEO
Authorized Official - Prefix:MR
Authorized Official - First Name:FATAI
Authorized Official - Middle Name:A
Authorized Official - Last Name:ADESIJI
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:614-218-0763
Mailing Address - Street 1:2425 DEEWOOD DR
Mailing Address - Street 2:
Mailing Address - City:COLUMBUS
Mailing Address - State:OH
Mailing Address - Zip Code:43229-2267
Mailing Address - Country:US
Mailing Address - Phone:614-776-3333
Mailing Address - Fax:614-776-5999
Practice Address - Street 1:2425 DEEWOOD DR
Practice Address - Street 2:
Practice Address - City:COLUMBUS
Practice Address - State:OH
Practice Address - Zip Code:43229-2267
Practice Address - Country:US
Practice Address - Phone:614-776-3333
Practice Address - Fax:614-776-5999
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-07-08
Last Update Date:2012-07-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OH1384398251E00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes251E00000XAgenciesHome Health
Provider Identifiers
StateIdentifier IDID TypeIssuer
OH2547426Medicaid
OH2547426Medicaid