Provider Demographics
NPI:1750159745
Name:ANGELS OF OHIO HOME CARE
Entity type:Organization
Organization Name:ANGELS OF OHIO HOME CARE
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:
Authorized Official - First Name:SHAFA
Authorized Official - Middle Name:
Authorized Official - Last Name:HASSAN
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:937-949-3272
Mailing Address - Street 1:4134 LINDEN AVE STE 307
Mailing Address - Street 2:
Mailing Address - City:DAYTON
Mailing Address - State:OH
Mailing Address - Zip Code:45432-3043
Mailing Address - Country:US
Mailing Address - Phone:937-949-3272
Mailing Address - Fax:
Practice Address - Street 1:4134 LINDEN AVE STE 307
Practice Address - Street 2:
Practice Address - City:DAYTON
Practice Address - State:OH
Practice Address - Zip Code:45432-3043
Practice Address - Country:US
Practice Address - Phone:937-949-3272
Practice Address - Fax:937-938-1220
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2023-12-19
Last Update Date:2023-12-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes374U00000XNursing Service Related ProvidersHome Health AideGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
OH0204280Medicaid