MEDICARE: RIVER'S CROSSING HOME HEALTH, LLC

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	251E00000X	Home Health Agency

General Provider Information

NPI Number	:	1225135122
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	RIVER'S CROSSING HOME HEALTH, LLC

Provider Business Mailing Address
First Line	:	600 E RICH ST
Second Line	:
City	:	COLUMBUS
State	:	OH
Zip	:	43215-5335
Country	:	US
Telephone Number	:	614-447-1690
Fax Number	:	614-447-2015

Provider Business Practice Location Address
First Line	:	2572 CLEVELAND AVE
Second Line	:
City	:	COLUMBUS
State	:	OH
Zip	:	43211-1644
Country	:	US
Telephone Number	:	614-447-1690
Fax Number	:	614-447-2015

Authorized Official
Title or Position	:	OWNER
Name	:	MR. VODRICK LEE PERRY
Credential	:	R.N
Telephone Number	:	614-238-0958

Provider Enumeration Date	:	09/20/2006
Last Update Date	:	10/14/2010

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