Provider Demographics
NPI:1891084166
Name:STAY WELL HOME HEALTH
Entity Type:Organization
Organization Name:STAY WELL HOME HEALTH
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:DELEGATE OFFICIAL
Authorized Official - Prefix:
Authorized Official - First Name:KIMBERLY
Authorized Official - Middle Name:
Authorized Official - Last Name:TILLEY
Authorized Official - Suffix:
Authorized Official - Credentials:RN
Authorized Official - Phone:513-297-4555
Mailing Address - Street 1:4000 EXECUTIVE PARK DR STE 225
Mailing Address - Street 2:
Mailing Address - City:CINCINNATI
Mailing Address - State:OH
Mailing Address - Zip Code:45241-4009
Mailing Address - Country:US
Mailing Address - Phone:513-297-4555
Mailing Address - Fax:513-297-4588
Practice Address - Street 1:4000 EXECUTIVE PARK DR STE 225
Practice Address - Street 2:
Practice Address - City:CINCINNATI
Practice Address - State:OH
Practice Address - Zip Code:45241-4009
Practice Address - Country:US
Practice Address - Phone:513-297-4555
Practice Address - Fax:513-297-4588
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2011-04-07
Last Update Date:2021-12-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OH368339251E00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes251E00000XAgenciesHome Health
Provider Identifiers
StateIdentifier IDID TypeIssuer
OH368339OtherMEDICARE