Provider Demographics
NPI:1780039750
Name:BUCKEYE STATE HOME HEALTHCARE LLC
Entity Type:Organization
Organization Name:BUCKEYE STATE HOME HEALTHCARE LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:MANAGER
Authorized Official - Prefix:MR
Authorized Official - First Name:ABDIKARIM
Authorized Official - Middle Name:M
Authorized Official - Last Name:ISSE
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:619-623-1792
Mailing Address - Street 1:1425 E DUBLIN GRANVILLE RD STE 201
Mailing Address - Street 2:
Mailing Address - City:COLUMBUS
Mailing Address - State:OH
Mailing Address - Zip Code:43229-3312
Mailing Address - Country:US
Mailing Address - Phone:619-623-1792
Mailing Address - Fax:
Practice Address - Street 1:1425 E DUBLIN GRANVILLE RD STE 201
Practice Address - Street 2:
Practice Address - City:COLUMBUS
Practice Address - State:OH
Practice Address - Zip Code:43229-3312
Practice Address - Country:US
Practice Address - Phone:619-623-1792
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2016-04-27
Last Update Date:2016-04-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes251E00000XAgenciesHome Health