Provider Demographics
NPI:1770844870
Name:LIBERTY HOME HEALTH CARE OF OHIO, INC
Entity Type:Organization
Organization Name:LIBERTY HOME HEALTH CARE OF OHIO, INC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:CEO
Authorized Official - Prefix:MRS
Authorized Official - First Name:FARHIYA
Authorized Official - Middle Name:
Authorized Official - Last Name:SHIRWA
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:614-825-9556
Mailing Address - Street 1:6161 BUSCH BLVD STE 76
Mailing Address - Street 2:
Mailing Address - City:COLUMBUS
Mailing Address - State:OH
Mailing Address - Zip Code:43229-2548
Mailing Address - Country:US
Mailing Address - Phone:614-825-9556
Mailing Address - Fax:
Practice Address - Street 1:6161 BUSCH BLVD STE 76
Practice Address - Street 2:
Practice Address - City:COLUMBUS
Practice Address - State:OH
Practice Address - Zip Code:43229-2548
Practice Address - Country:US
Practice Address - Phone:614-825-9556
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2012-06-05
Last Update Date:2012-06-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OH2108085251E00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes251E00000XAgenciesHome Health
Provider Identifiers
StateIdentifier IDID TypeIssuer
OH1Medicaid