Healthcare Provider Details

I. General information

NPI: 1245442011
Provider Name (Legal Business Name): HOMESITE HOME HEALTH CARE LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 05/04/2007
Last Update Date: 06/28/2024
Certification Date: 06/28/2024
Deactivation Date:
Reactivation Date:

III. Provider practice location address

4800 URBANA RD STE 103
SPRINGFIELD OH
45502-8323
US

IV. Provider business mailing address

4800 URBANA RD STE 103
SPRINGFIELD OH
45502-8323
US

V. Phone/Fax

Practice location:
  • Phone: 937-717-0158
  • Fax: 937-717-0139
Mailing address:
  • Phone: 937-717-0158
  • Fax: 937-717-0139

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code251E00000X
TaxonomyHome Health Agency
License NumberOH03566
License Number StateOH

VIII. Authorized Official

Name: MS. MARY D PENCIL
Title or Position: ADMINISTRATOR
Credential: RN
Phone: 937-717-0158