Healthcare Provider Details

I. General information

NPI: 1275092835
Provider Name (Legal Business Name): KNIGHTENGALES HOME CARE LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 03/13/2019
Last Update Date: 03/19/2019
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

4990 NEBRASKA AVE STE 3
HUBER HEIGHTS OH
45424-6136
US

IV. Provider business mailing address

4990 NEBRASKA AVE STE 3
HUBER HEIGHTS OH
45424-6136
US

V. Phone/Fax

Practice location:
  • Phone: 937-949-8735
  • Fax:
Mailing address:
  • Phone: 937-949-8735
  • Fax: 937-951-3794

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 Code251J00000X
TaxonomyNursing Care Agency
License Number
License Number State

VIII. Authorized Official

Name: MISS NANCY E LEE
Title or Position: OWNER
Credential:
Phone: 937-620-1106