Healthcare Provider Details

I. General information

NPI: 1134587108
Provider Name (Legal Business Name): ADDISON HOME HEALTH SERVICES LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 02/05/2016
Last Update Date: 10/11/2019
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1819 TROY ST STE 3
DAYTON OH
45404
US

IV. Provider business mailing address

1819 TROY ST STE 3
DAYTON OH
45404-2400
US

V. Phone/Fax

Practice location:
  • Phone: 888-570-1152
  • Fax: 937-771-1661
Mailing address:
  • Phone: 888-570-1152
  • Fax: 937-771-1661

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code251E00000X
TaxonomyHome Health Agency
License Number
License Number StateOH
# 2
Primary TaxonomyN
Taxonomy Code251J00000X
TaxonomyNursing Care Agency
License Number
License Number StateOH
# 3
Primary TaxonomyN
Taxonomy Code253Z00000X
TaxonomyIn Home Supportive Care Agency
License Number
License Number StateOH

VIII. Authorized Official

Name: MR. ISLOM SHAKHBANDAROV
Title or Position: CEO
Credential:
Phone: 888-570-1152