Healthcare Provider Details

I. General information

NPI: 1780341495
Provider Name (Legal Business Name): MY FATHERS HOUSE HOME CARE LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 11/17/2021
Last Update Date: 12/15/2021
Certification Date: 12/15/2021
Deactivation Date:
Reactivation Date:

III. Provider practice location address

5808 MONROE ST
SYLVANIA OH
43560-2268
US

IV. Provider business mailing address

5808 MONROE ST
SYLVANIA OH
43560-2268
US

V. Phone/Fax

Practice location:
  • Phone: 419-460-9264
  • Fax:
Mailing address:
  • Phone: 419-377-3833
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code253Z00000X
TaxonomyIn Home Supportive Care Agency
License Number
License Number State
# 2
Primary TaxonomyN
Taxonomy Code376J00000X
TaxonomyHomemaker
License Number
License Number State

VIII. Authorized Official

Name: SHARLON DENISE EDWARDS
Title or Position: CEO
Credential:
Phone: 419-460-9264