Provider Demographics
NPI:1912249509
Name:IMMACULATE HOMEHEALTH CARE SERVICES LLC
Entity Type:Organization
Organization Name:IMMACULATE HOMEHEALTH CARE SERVICES LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:ADMINISTRATOR
Authorized Official - Prefix:MRS
Authorized Official - First Name:BRENDA
Authorized Official - Middle Name:CHINONSO
Authorized Official - Last Name:UZOMBA
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:614-569-1236
Mailing Address - Street 1:2999 E DUBLIN GRANVILLE RD STE 214
Mailing Address - Street 2:
Mailing Address - City:COLUMBUS
Mailing Address - State:OH
Mailing Address - Zip Code:43231-4030
Mailing Address - Country:US
Mailing Address - Phone:614-392-1865
Mailing Address - Fax:614-392-1866
Practice Address - Street 1:5670 WESTBOURNE AVE
Practice Address - Street 2:
Practice Address - City:COLUMBUS
Practice Address - State:OH
Practice Address - Zip Code:43213-1485
Practice Address - Country:US
Practice Address - Phone:614-569-1236
Practice Address - Fax:614-392-1866
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2013-03-21
Last Update Date:2019-08-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes251E00000XAgenciesHome Health