Healthcare Provider Details

I. General information

NPI: 1104772243
Provider Name (Legal Business Name): PROVIDER HOME HEALTHCARE LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 03/10/2026
Last Update Date: 03/10/2026
Certification Date: 03/10/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

5754 BALSAM DR
LIBERTY TOWNSHIP OH
45044-8602
US

IV. Provider business mailing address

5754 BALSAM DR
LIBERTY TOWNSHIP OH
45044-8602
US

V. Phone/Fax

Practice location:
  • Phone: 513-442-1802
  • Fax: 513-442-2050
Mailing address:
  • Phone: 513-442-1802
  • Fax: 513-442-2050

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code251E00000X
TaxonomyHome Health Agency
License Number
License Number State

VIII. Authorized Official

Name: SHEENA KAMBULE
Title or Position: CEO
Credential: RN
Phone: 513-808-8872