Provider Demographics
NPI:1134646110
Name:TENNYSON HEALTH CARE SERVICES INC.
Entity type:Organization
Organization Name:TENNYSON HEALTH CARE SERVICES INC.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT/CEO
Authorized Official - Prefix:MRS
Authorized Official - First Name:SUSIE
Authorized Official - Middle Name:E
Authorized Official - Last Name:DIBO NGALLE
Authorized Official - Suffix:
Authorized Official - Credentials:BSDH, RDH
Authorized Official - Phone:937-212-9834
Mailing Address - Street 1:6520 POE AVE STE 170
Mailing Address - Street 2:
Mailing Address - City:DAYTON
Mailing Address - State:OH
Mailing Address - Zip Code:45414-2858
Mailing Address - Country:US
Mailing Address - Phone:937-387-9209
Mailing Address - Fax:937-836-2368
Practice Address - Street 1:6520 POE AVE STE 170
Practice Address - Street 2:
Practice Address - City:DAYTON
Practice Address - State:OH
Practice Address - Zip Code:45414-2858
Practice Address - Country:US
Practice Address - Phone:937-212-9834
Practice Address - Fax:937-387-9356
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2017-08-29
Last Update Date:2025-05-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OH011139163WH0200X, 251E00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes251E00000XAgenciesHome Health
No163WH0200XNursing Service ProvidersRegistered NurseHome HealthGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
OH0274590Medicaid