Provider Demographics
NPI:1205122710
Name:MEDEX HOME HEALTHCARE, INCORPORATED
Entity type:Organization
Organization Name:MEDEX HOME HEALTHCARE, INCORPORATED
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT/CEO
Authorized Official - Prefix:
Authorized Official - First Name:NELSON
Authorized Official - Middle Name:
Authorized Official - Last Name:HODOGBEY
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:773-294-1477
Mailing Address - Street 1:1338 BROADWAY
Mailing Address - Street 2:
Mailing Address - City:GARY
Mailing Address - State:IN
Mailing Address - Zip Code:46407-1309
Mailing Address - Country:US
Mailing Address - Phone:773-294-1477
Mailing Address - Fax:
Practice Address - Street 1:1338 BROADWAY
Practice Address - Street 2:
Practice Address - City:GARY
Practice Address - State:IN
Practice Address - Zip Code:46407-1309
Practice Address - Country:US
Practice Address - Phone:773-294-1477
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2011-06-22
Last Update Date:2011-06-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IN11-012603-1251E00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes251E00000XAgenciesHome Health