Provider Demographics
NPI:1821101601
Name:EBE HEALTHCARE, LLC
Entity Type:Organization
Organization Name:EBE HEALTHCARE, LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:CEO
Authorized Official - Prefix:
Authorized Official - First Name:NICK
Authorized Official - Middle Name:ROBERT
Authorized Official - Last Name:KING
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:614-501-7802
Mailing Address - Street 1:467 WATERBURY CT
Mailing Address - Street 2:
Mailing Address - City:GAHANNA
Mailing Address - State:OH
Mailing Address - Zip Code:43230-5313
Mailing Address - Country:US
Mailing Address - Phone:614-414-0057
Mailing Address - Fax:614-414-0052
Practice Address - Street 1:467 WATERBURY CT
Practice Address - Street 2:
Practice Address - City:GAHANNA
Practice Address - State:OH
Practice Address - Zip Code:43230-5313
Practice Address - Country:US
Practice Address - Phone:614-414-0057
Practice Address - Fax:614-414-0052
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-08-16
Last Update Date:2016-11-04
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OH2517093251E00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes251E00000XAgenciesHome Health
Provider Identifiers
StateIdentifier IDID TypeIssuer
OH2517093Medicaid
OH368075Medicare Oscar/Certification