=====================================================
General NPI Number Information
=====================================================
NPI Number | 1033465240
-----------------------------------------------------
Entity Type | Organization
-----------------------------------------------------
Legal Business Name | WORTHINGTON HOME HEALTHCARE, LLC
-----------------------------------------------------
=====================================================
Dates
=====================================================
Enumeration Date | 07/25/2012
-----------------------------------------------------
Last Update Date | 07/25/2012
-----------------------------------------------------
=====================================================
Provider Practice Location Address
=====================================================
Address Line | 500 W WILSON BRIDGE RD SUITE 35
-----------------------------------------------------
City | WORTHINGTON
-----------------------------------------------------
State | OH
-----------------------------------------------------
Zip | 43085-2238
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 614-634-6500
-----------------------------------------------------
Fax | 614-750-1209
-----------------------------------------------------
=====================================================
Provider Business Mailing Address
=====================================================
Address Line | 500 W WILSON BRIDGE RD SUITE 35
-----------------------------------------------------
City | WORTHINGTON
-----------------------------------------------------
State | OH
-----------------------------------------------------
Zip | 43085-2238
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 614-634-6500
-----------------------------------------------------
Fax | 614-750-1209
-----------------------------------------------------
=====================================================
Authorized Official
=====================================================
Title or Position | OWNER
-----------------------------------------------------
Name | KELLI GARRISON
-----------------------------------------------------
Credential |
-----------------------------------------------------
Telephone | 614-634-6500
-----------------------------------------------------
=====================================================
Scope of Practice (Provider's specialty)
=====================================================
Taxonomy #1
-----------------------------------------------------
Taxonomy Code | 251E00000X
-----------------------------------------------------
Taxonomy Name | Home Health Agency
-----------------------------------------------------
License Number | 2110439
-----------------------------------------------------
License Number State | OH
-----------------------------------------------------