Healthcare Provider Details

I. General information

NPI: 1659912293
Provider Name (Legal Business Name): IDEAL HOMEHEALTH AGENCY, LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 10/04/2019
Last Update Date: 03/22/2024
Certification Date: 01/02/2024
Deactivation Date:
Reactivation Date:

III. Provider practice location address

275 CURRY HOLLOW RD STE G300
PITTSBURGH PA
15236-4631
US

IV. Provider business mailing address

101 TOWNE SQUARE WAY STE 281
PITTSBURGH PA
15227-3259
US

V. Phone/Fax

Practice location:
  • Phone: 412-653-1060
  • Fax: 412-653-1045
Mailing address:
  • Phone: 412-653-1060
  • Fax: 412-653-1045

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code225100000X
TaxonomyPhysical Therapist
License Number
License Number State
# 2
Primary TaxonomyN
Taxonomy Code374U00000X
TaxonomyHome Health Aide
License Number
License Number State
# 3
Primary TaxonomyN
Taxonomy Code104100000X
TaxonomySocial Worker
License Number
License Number State
# 4
Primary TaxonomyN
Taxonomy Code163WH0200X
TaxonomyHome Health Registered Nurse
License Number
License Number State
# 5
Primary TaxonomyN
Taxonomy Code224ZF0002X
TaxonomyFeeding, Eating & Swallowing Occupational Therapy Assistant
License Number
License Number State
# 6
Primary TaxonomyY
Taxonomy Code251E00000X
TaxonomyHome Health Agency
License Number
License Number State

VIII. Authorized Official

Name: LAXMI N KHATIWADA
Title or Position: BUSINESS MANAGER/OWNER
Credential:
Phone: 412-653-1060