Healthcare Provider Details

I. General information

NPI: 1013723014
Provider Name (Legal Business Name): PLATINUM HOME HEALTHCARE
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 12/05/2024
Last Update Date: 12/05/2024
Certification Date: 12/05/2024
Deactivation Date:
Reactivation Date:

III. Provider practice location address

436 CREST HILL AVE
VANDALIA OH
45377-1557
US

IV. Provider business mailing address

436 CREST HILL AVE
VANDALIA OH
45377-1557
US

V. Phone/Fax

Practice location:
  • Phone: 937-479-8449
  • Fax:
Mailing address:
  • Phone: 937-479-8449
  • 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 Code347C00000X
TaxonomyPrivate Vehicle
License Number
License Number State
# 3
Primary TaxonomyN
Taxonomy Code385H00000X
TaxonomyRespite Care
License Number
License Number State

VIII. Authorized Official

Name: GERARD NJUMASHUA
Title or Position: CEO
Credential:
Phone: 937-479-8449