MEDICARE: ICONIC HOME HEALTHCARE 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	:	1396673349
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	ICONIC HOME HEALTHCARE LLC

Provider Business Mailing Address
First Line	:	8415 BENT MAPLE CT
Second Line	:
City	:	BLACKLICK
State	:	OH
Zip	:	43004-9090
Country	:	US
Telephone Number	:	571-426-4822
Fax Number	:

Provider Business Practice Location Address
First Line	:	8415 BENT MAPLE CT
Second Line	:
City	:	BLACKLICK
State	:	OH
Zip	:	43004-9090
Country	:	US
Telephone Number	:	571-426-4822
Fax Number	:

Authorized Official
Title or Position	:	DIRECTOR OF OPERATIONS
Name	:	NANA A ADU-POKU
Credential	:
Telephone Number	:	571-426-4822

Provider Enumeration Date	:	05/11/2026
Last Update Date	:	05/11/2026

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Directions to “ICONIC HOME HEALTHCARE LLC ” Practice Location

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