Provider Demographics
NPI:1982098893
Name:ANOVYCARE HOME HEALTH AGENCY LLC
Entity Type:Organization
Organization Name:ANOVYCARE HOME HEALTH AGENCY LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:SUPERVISOR
Authorized Official - Prefix:
Authorized Official - First Name:OPEOLU
Authorized Official - Middle Name:0
Authorized Official - Last Name:FAWOLE
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:678-855-1226
Mailing Address - Street 1:10999 REED HARTMAN HWY
Mailing Address - Street 2:SUITE 210
Mailing Address - City:BLUE ASH
Mailing Address - State:OH
Mailing Address - Zip Code:45242-8331
Mailing Address - Country:US
Mailing Address - Phone:678-855-1226
Mailing Address - Fax:
Practice Address - Street 1:10999 REED HARTMAN HWY
Practice Address - Street 2:SUITE 210
Practice Address - City:BLUE ASH
Practice Address - State:OH
Practice Address - Zip Code:45242-8331
Practice Address - Country:US
Practice Address - Phone:513-550-4469
Practice Address - Fax:513-672-2137
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2015-03-28
Last Update Date:2021-07-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes253Z00000XAgenciesIn Home Supportive Care
No251E00000XAgenciesHome Health
No385HR2060XRespite Care FacilityRespite CareRespite Care, Intellectual and/or Developmental Disabilities, Child
Provider Identifiers
StateIdentifier IDID TypeIssuer
OH0189047Medicaid
OH0136754OtherODJFS MEDICAID PROVIDER NUMBER