=====================================================
General NPI Number Information
=====================================================
NPI Number | 1194416958
-----------------------------------------------------
Entity Type | Organization
-----------------------------------------------------
Legal Business Name | OHC OF NC OHIO LLC
-----------------------------------------------------
=====================================================
Dates
=====================================================
Enumeration Date | 05/15/2023
-----------------------------------------------------
Last Update Date | 05/01/2024
-----------------------------------------------------
=====================================================
Provider Practice Location Address
=====================================================
Address Line | 28315 KENSINGTON LN
-----------------------------------------------------
City | PERRYSBURG
-----------------------------------------------------
State | OH
-----------------------------------------------------
Zip | 43551-4164
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 419-843-4422
-----------------------------------------------------
Fax | 419-843-4442
-----------------------------------------------------
=====================================================
Provider Business Mailing Address
=====================================================
Address Line | 28276 KENSINGTON LN
-----------------------------------------------------
City | PERRYSBURG
-----------------------------------------------------
State | OH
-----------------------------------------------------
Zip | 43551-4178
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 419-843-4422
-----------------------------------------------------
Fax | 419-843-4442
-----------------------------------------------------
=====================================================
Authorized Official
=====================================================
Title or Position | CEO
-----------------------------------------------------
Name | MR. JOSH A ADAMS
-----------------------------------------------------
Credential |
-----------------------------------------------------
Telephone | 419-843-4422
-----------------------------------------------------
=====================================================
Scope of Practice (Provider's specialty)
=====================================================
Taxonomy #1
-----------------------------------------------------
Taxonomy Code | 251G00000X
-----------------------------------------------------
Taxonomy Name | Community Based Hospice Care Agency
-----------------------------------------------------
License Number |
-----------------------------------------------------
License Number State |
-----------------------------------------------------