Provider Demographics
NPI:1245239706
Name:CONSTANCE CARE HOME HEALTHCARE
Entity type:Organization
Organization Name:CONSTANCE CARE HOME HEALTHCARE
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:SENIOR VICE PRESIDENT
Authorized Official - Prefix:MR
Authorized Official - First Name:DONALD
Authorized Official - Middle Name:LEO
Authorized Official - Last Name:BRADLEY
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:740-477-8689
Mailing Address - Street 1:774 N COURT ST
Mailing Address - Street 2:
Mailing Address - City:CIRCLEVILLE
Mailing Address - State:OH
Mailing Address - Zip Code:43113-1262
Mailing Address - Country:US
Mailing Address - Phone:740-477-8689
Mailing Address - Fax:740-477-8693
Practice Address - Street 1:774 N COURT ST
Practice Address - Street 2:
Practice Address - City:CIRCLEVILLE
Practice Address - State:OH
Practice Address - Zip Code:43113-1262
Practice Address - Country:US
Practice Address - Phone:740-477-8689
Practice Address - Fax:740-477-8693
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2005-07-18
Last Update Date:2008-04-29
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes251E00000XAgenciesHome Health
Provider Identifiers
StateIdentifier IDID TypeIssuer
OH2234666Medicaid
OH2234666Medicaid