Healthcare Provider Details

I. General information

NPI: 1407152853
Provider Name (Legal Business Name): ICU HOME HEALTHCARE, LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 02/02/2011
Last Update Date: 02/02/2011
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

11777 IDEAL RD
BYESVILLE OH
43723-9523
US

IV. Provider business mailing address

11777 IDEAL RD
BYESVILLE OH
43723-9523
US

V. Phone/Fax

Practice location:
  • Phone: 740-685-2674
  • Fax: 740-685-2674
Mailing address:
  • Phone: 740-685-2674
  • Fax: 740-685-2674

VI. Provider taxonomy

Scope of Practice (Provider specialty)

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

VIII. Authorized Official

Name: NORMAN NATHAN GINN
Title or Position: CEO
Credential: RN
Phone: 740-685-2674