Healthcare Provider Details

I. General information

NPI: 1194260844
Provider Name (Legal Business Name): CENTENNIAL HOME CARE, LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 01/04/2017
Last Update Date: 09/14/2026
Certification Date: 09/14/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1010 JACKSON HOLE DR STE 200
BLACKLICK OH
43004-6051
US

IV. Provider business mailing address

1010 JACKSON HOLE DR STE 200
BLACKLICK OH
43004-6051
US

V. Phone/Fax

Practice location:
  • Phone: 740-209-6105
  • Fax:
Mailing address:
  • Phone: 740-209-6105
  • Fax: 740-209-6105

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code251E00000X
TaxonomyHome Health Agency
License Number3969539
License Number StateOH

VIII. Authorized Official

Name: LEIGH MILTIMORE
Title or Position: DIRECTOR OF COMPLIANCE
Credential:
Phone: 740-209-6105