=====================================================
General NPI Number Information
=====================================================
NPI Number | 1245442011
-----------------------------------------------------
Entity Type | Organization
-----------------------------------------------------
Legal Business Name | HOMESITE HOME HEALTH CARE LLC
-----------------------------------------------------
=====================================================
Dates
=====================================================
Enumeration Date | 05/04/2007
-----------------------------------------------------
Last Update Date | 06/28/2024
-----------------------------------------------------
=====================================================
Provider Practice Location Address
=====================================================
Address Line | 4800 URBANA RD STE 103
-----------------------------------------------------
City | SPRINGFIELD
-----------------------------------------------------
State | OH
-----------------------------------------------------
Zip | 45502-8323
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 937-717-0158
-----------------------------------------------------
Fax | 937-717-0139
-----------------------------------------------------
=====================================================
Provider Business Mailing Address
=====================================================
Address Line | 4800 URBANA RD STE 103
-----------------------------------------------------
City | SPRINGFIELD
-----------------------------------------------------
State | OH
-----------------------------------------------------
Zip | 45502-8323
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 937-717-0158
-----------------------------------------------------
Fax | 937-717-0139
-----------------------------------------------------
=====================================================
Authorized Official
=====================================================
Title or Position | ADMINISTRATOR
-----------------------------------------------------
Name | MS. MARY D PENCIL
-----------------------------------------------------
Credential | RN
-----------------------------------------------------
Telephone | 937-717-0158
-----------------------------------------------------
=====================================================
Scope of Practice (Provider's specialty)
=====================================================
Taxonomy #1
-----------------------------------------------------
Taxonomy Code | 251E00000X
-----------------------------------------------------
Taxonomy Name | Home Health Agency
-----------------------------------------------------
License Number | OH03566
-----------------------------------------------------
License Number State | OH
-----------------------------------------------------