Provider Demographics
NPI:1972192318
Name:HORNER & COMPANY
Entity Type:Organization
Organization Name:HORNER & COMPANY
Other - Org Name:KINGDOM C.A.R.E.S.
Other - Org Type:Doing Business As
Authorized Official - Title/Position:OWNER/PRESIDENT
Authorized Official - Prefix:
Authorized Official - First Name:DOMINGA
Authorized Official - Middle Name:
Authorized Official - Last Name:HORNER
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:234-214-8668
Mailing Address - Street 1:3757 CLEVELAND AVE NW STE 200
Mailing Address - Street 2:
Mailing Address - City:CANTON
Mailing Address - State:OH
Mailing Address - Zip Code:44709-2375
Mailing Address - Country:US
Mailing Address - Phone:234-214-8668
Mailing Address - Fax:234-214-8364
Practice Address - Street 1:3757 CLEVELAND AVE NW STE 200
Practice Address - Street 2:
Practice Address - City:CANTON
Practice Address - State:OH
Practice Address - Zip Code:44709-2375
Practice Address - Country:US
Practice Address - Phone:234-214-8668
Practice Address - Fax:234-214-8364
EIN:<UNAVAIL>
Is Organization Subpart?:Yes
Parent Organization LBN:HORNER & COMPANY
Parent Organization TIN:<UNAVAIL>
Enumeration Date:2021-01-11
Last Update Date:2021-08-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes251E00000XAgenciesHome Health
Provider Identifiers
StateIdentifier IDID TypeIssuer
OH1972192318Medicaid