Provider Demographics
NPI:1972816882
Name:EMANCICARE HOME HEALTH LLC
Entity Type:Organization
Organization Name:EMANCICARE HOME HEALTH LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:CHIEF EXECUTIVE OFFICER
Authorized Official - Prefix:MR
Authorized Official - First Name:ROBERT
Authorized Official - Middle Name:W
Authorized Official - Last Name:VANSICKLE
Authorized Official - Suffix:III
Authorized Official - Credentials:
Authorized Official - Phone:614-547-0282
Mailing Address - Street 1:4889 SINCLAIR RD
Mailing Address - Street 2:SUITE 105
Mailing Address - City:COLUMBUS
Mailing Address - State:OH
Mailing Address - Zip Code:43229-5432
Mailing Address - Country:US
Mailing Address - Phone:614-547-0282
Mailing Address - Fax:614-547-0284
Practice Address - Street 1:4889 SINCLAIR RD
Practice Address - Street 2:SUITE 105
Practice Address - City:COLUMBUS
Practice Address - State:OH
Practice Address - Zip Code:43229-5432
Practice Address - Country:US
Practice Address - Phone:614-547-0282
Practice Address - Fax:614-547-0284
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2010-07-20
Last Update Date:2013-10-30
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes251E00000XAgenciesHome Health
Provider Identifiers
StateIdentifier IDID TypeIssuer
OH282760064OtherPASSPORT
OH2495152Medicaid
OH282760064OtherPASSPORT