Healthcare Provider Details

I. General information

NPI: 1396673349
Provider Name (Legal Business Name): ICONIC HOME HEALTHCARE LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 05/11/2026
Last Update Date: 05/11/2026
Certification Date: 05/11/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

8415 BENT MAPLE CT
BLACKLICK OH
43004-9090
US

IV. Provider business mailing address

8415 BENT MAPLE CT
BLACKLICK OH
43004-9090
US

V. Phone/Fax

Practice location:
  • Phone: 571-426-4822
  • Fax:
Mailing address:
  • Phone: 571-426-4822
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code251E00000X
TaxonomyHome Health Agency
License Number
License Number State

VIII. Authorized Official

Name: NANA A ADU-POKU
Title or Position: DIRECTOR OF OPERATIONS
Credential:
Phone: 571-426-4822