Healthcare Provider Details

I. General information

NPI: 1003514381
Provider Name (Legal Business Name): IDEAL HOME CARE
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 02/16/2023
Last Update Date: 02/16/2023
Certification Date: 02/13/2023
Deactivation Date:
Reactivation Date:

III. Provider practice location address

3448 TALLAHASSEE DR
CINCINNATI OH
45239-7147
US

IV. Provider business mailing address

3448 TALLAHASSEE DR
CINCINNATI OH
45239-7147
US

V. Phone/Fax

Practice location:
  • Phone: 513-405-3760
  • Fax:
Mailing address:
  • Phone: 513-405-3760
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code253Z00000X
TaxonomyIn Home Supportive Care Agency
License Number
License Number State
# 2
Primary TaxonomyN
Taxonomy Code385H00000X
TaxonomyRespite Care
License Number
License Number State
# 3
Primary TaxonomyN
Taxonomy Code385HR2060X
TaxonomyChild Intellectual and/or Developmental Disabilities Respite Care
License Number
License Number State

VIII. Authorized Official

Name: TISA N. WALTON
Title or Position: DIRECTOR OF OPERATIONS
Credential:
Phone: 513-405-3760