Provider Demographics
NPI:1265783278
Name:TARGET HEALTH CARE LLC
Entity type:Organization
Organization Name:TARGET HEALTH CARE LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:ADMINISTRATIVE DIRECTOR
Authorized Official - Prefix:MRS
Authorized Official - First Name:SYLVIE
Authorized Official - Middle Name:MUKANSE
Authorized Official - Last Name:WAMBA
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:513-609-8524
Mailing Address - Street 1:11497 SPRINGFIELD PIKE STE 7
Mailing Address - Street 2:
Mailing Address - City:SPRINGDALE
Mailing Address - State:OH
Mailing Address - Zip Code:45246-3551
Mailing Address - Country:US
Mailing Address - Phone:513-609-8524
Mailing Address - Fax:513-426-8641
Practice Address - Street 1:11497 SPRINGFIELD PIKE STE 7
Practice Address - Street 2:
Practice Address - City:SPRINGDALE
Practice Address - State:OH
Practice Address - Zip Code:45246-3551
Practice Address - Country:US
Practice Address - Phone:513-426-8492
Practice Address - Fax:513-426-8641
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2012-10-01
Last Update Date:2021-02-04
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OH201226801156251E00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes251E00000XAgenciesHome Health
Provider Identifiers
StateIdentifier IDID TypeIssuer
OH0085915Medicaid