MEDICARE: DOMINION HOME HEALTH AGENCY

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	:	1407272099
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	DOMINION HOME HEALTH AGENCY

Provider Business Mailing Address
First Line	:	3955 SNOWSHOE AVE
Second Line	:
City	:	GROVE CITY
State	:	OH
Zip	:	43123-1198
Country	:	US
Telephone Number	:
Fax Number	:

Provider Business Practice Location Address
First Line	:	3955 SNOWSHOE AVE
Second Line	:
City	:	GROVE CITY
State	:	OH
Zip	:	43123-1198
Country	:	US
Telephone Number	:	614-209-9340
Fax Number	:

Authorized Official
Title or Position	:	REGISTERED NURSE
Name	:	MRS. MABEL AGGOE-OPOKU
Credential	:	RN BSN
Telephone Number	:	614-209-9340

Provider Enumeration Date	:	03/06/2014
Last Update Date	:	03/06/2014

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