Provider Demographics
NPI:1790779221
Name:COMMUNITY MERCY HOME CARE SERVICES OF SPRINGFIELD, LLC
Entity Type:Organization
Organization Name:COMMUNITY MERCY HOME CARE SERVICES OF SPRINGFIELD, LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:VP FINANCE CFO
Authorized Official - Prefix:
Authorized Official - First Name:JACK
Authorized Official - Middle Name:
Authorized Official - Last Name:HAWKINS
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:513-576-8478
Mailing Address - Street 1:6281 TRI RIDGE BLVD STE 300
Mailing Address - Street 2:
Mailing Address - City:LOVELAND
Mailing Address - State:OH
Mailing Address - Zip Code:45140-8345
Mailing Address - Country:US
Mailing Address - Phone:513-576-8472
Mailing Address - Fax:
Practice Address - Street 1:1111 N PLUM ST STE 5
Practice Address - Street 2:
Practice Address - City:SPRINGFIELD
Practice Address - State:OH
Practice Address - Zip Code:45504-2154
Practice Address - Country:US
Practice Address - Phone:937-328-5113
Practice Address - Fax:937-521-2305
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2005-09-12
Last Update Date:2023-05-01
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes251E00000XAgenciesHome Health
Provider Identifiers
StateIdentifier IDID TypeIssuer
OH2269478Medicaid
OH2269478Medicaid