Provider Demographics
NPI:1295702488
Name:OHIO HEALTH ENTERPRISES, INC.
Entity type:Organization
Organization Name:OHIO HEALTH ENTERPRISES, INC.
Other - Org Name:<UNAVAIL>
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:MR
Authorized Official - First Name:SAMUEL
Authorized Official - Middle Name:JOHN
Authorized Official - Last Name:GRAHAM
Authorized Official - Suffix:III
Authorized Official - Credentials:
Authorized Official - Phone:614-733-0333
Mailing Address - Street 1:6618 CASTLEFORBES CT
Mailing Address - Street 2:
Mailing Address - City:DUBLIN
Mailing Address - State:OH
Mailing Address - Zip Code:43016-8419
Mailing Address - Country:US
Mailing Address - Phone:614-733-0333
Mailing Address - Fax:614-873-0727
Practice Address - Street 1:6618 CASTLEFORBES CT
Practice Address - Street 2:
Practice Address - City:DUBLIN
Practice Address - State:OH
Practice Address - Zip Code:43016-8419
Practice Address - Country:US
Practice Address - Phone:614-733-0333
Practice Address - Fax:614-873-0727
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-03-07
Last Update Date:2020-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OH25-288968332B00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes332B00000XSuppliersDurable Medical Equipment & Medical Supplies
Provider Identifiers
StateIdentifier IDID TypeIssuer
OH000000155155OtherANTHEM PROVIDER NUMBER
OH0854026Medicaid
OH0854026Medicaid