Healthcare Provider Details

I. General information

NPI: 1902521065
Provider Name (Legal Business Name): IN HOME HEALTH, LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 10/11/2022
Last Update Date: 10/11/2022
Certification Date: 10/11/2022
Deactivation Date:
Reactivation Date:

III. Provider practice location address

N6650 ROLLING MEADOWS DR STE 1
FOND DU LAC WI
54937-9471
US

IV. Provider business mailing address

333 N SUMMIT ST
TOLEDO OH
43604-1531
US

V. Phone/Fax

Practice location:
  • Phone: 920-926-1144
  • Fax:
Mailing address:
  • Phone: 567-585-1191
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207RH0002X
TaxonomyHospice and Palliative Medicine (Internal Medicine) Physician
License Number
License Number State

VIII. Authorized Official

Name: MARTIN DAVID ALLEN
Title or Position: DIRECTOR
Credential:
Phone: 419-252-5734