Healthcare Provider Details

I. General information

NPI: 1679481857
Provider Name (Legal Business Name): EXECUTIVE HOME CARE LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 08/31/2026
Last Update Date: 08/31/2026
Certification Date: 08/30/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

5890 LIVE OAK DR
TOLEDO OH
43613-5645
US

IV. Provider business mailing address

5890 LIVE OAK DR
TOLEDO OH
43613-5645
US

V. Phone/Fax

Practice location:
  • Phone: 419-345-1931
  • Fax:
Mailing address:
  • Phone: 419-345-1931
  • Fax:

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: BRYONNE DEJESUS LUPICA
Title or Position: CEO
Credential:
Phone: 419-345-1931