Healthcare Provider Details

I. General information

NPI: 1275170425
Provider Name (Legal Business Name): MCCARTY HOME HEALTH AND HOSPICE LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 12/06/2019
Last Update Date: 12/06/2019
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

6733 LAGRANGE DR
CANAL WINCHESTER OH
43110-8384
US

IV. Provider business mailing address

6733 LAGRANGE DR
CANAL WINCHESTER OH
43110-8384
US

V. Phone/Fax

Practice location:
  • Phone: 740-583-0740
  • Fax:
Mailing address:
  • Phone: 740-583-0740
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code251E00000X
TaxonomyHome Health Agency
License Number
License Number State
# 2
Primary TaxonomyN
Taxonomy Code251F00000X
TaxonomyHome Infusion Agency
License Number
License Number State
# 3
Primary TaxonomyN
Taxonomy Code251G00000X
TaxonomyCommunity Based Hospice Care Agency
License Number
License Number State

VIII. Authorized Official

Name: JUSTIN DANIEL TOLLIVER
Title or Position: DIRECTOR OF OPERATION
Credential: LPN
Phone: 740-583-0740