Healthcare Provider Details

I. General information

NPI: 1184515884
Provider Name (Legal Business Name): CEDAR HOME CARE LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 07/10/2025
Last Update Date: 07/10/2025
Certification Date: 07/10/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2555 S DIXIE DR STE 284
KETTERING OH
45409-1543
US

IV. Provider business mailing address

2555 S DIXIE DR STE 284
KETTERING OH
45409-1543
US

V. Phone/Fax

Practice location:
  • Phone: 614-300-0394
  • Fax:
Mailing address:
  • Phone:
  • 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 Code251J00000X
TaxonomyNursing Care Agency
License Number
License Number State
# 3
Primary TaxonomyN
Taxonomy Code261QP2000X
TaxonomyPhysical Therapy Clinic/Center
License Number
License Number State

VIII. Authorized Official

Name: MOKHTAR ISSA
Title or Position: OWNER
Credential:
Phone: 614-300-0394