Healthcare Provider Details

I. General information

NPI: 1720142573
Provider Name (Legal Business Name): CARE AT HOME BY GREEN HILLS LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 12/19/2006
Last Update Date: 03/13/2020
Certification Date: 03/13/2020
Deactivation Date:
Reactivation Date:

III. Provider practice location address

921 RUSH AVE
BELLEFONTAINE OH
43311-2358
US

IV. Provider business mailing address

921 RUSH AVE
BELLEFONTAINE OH
43311-2358
US

V. Phone/Fax

Practice location:
  • Phone: 937-599-4940
  • Fax:
Mailing address:
  • Phone: 937-599-4940
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code251G00000X
TaxonomyCommunity Based Hospice Care Agency
License Number0022HSP
License Number StateOH

VIII. Authorized Official

Name: STEPHANIE CHRISTOPHER
Title or Position: CFO
Credential:
Phone: 937-465-5065