=====================================================
General NPI Number Information
=====================================================
NPI Number | 1568887305
-----------------------------------------------------
Entity Type | Organization
-----------------------------------------------------
Legal Business Name | INTERIM HEALTHCARE OF SE OHIO INC.
-----------------------------------------------------
=====================================================
Dates
=====================================================
Enumeration Date | 03/04/2014
-----------------------------------------------------
Last Update Date | 08/16/2024
-----------------------------------------------------
=====================================================
Provider Practice Location Address
=====================================================
Address Line | 121 E MAIN ST
-----------------------------------------------------
City | SAINT CLAIRSVILLE
-----------------------------------------------------
State | OH
-----------------------------------------------------
Zip | 43950-1527
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 740-635-0045
-----------------------------------------------------
Fax | 740-635-0470
-----------------------------------------------------
=====================================================
Provider Business Mailing Address
=====================================================
Address Line | 300 W WILSON BRIDGE RD STE 250
-----------------------------------------------------
City | WORTHINGTON
-----------------------------------------------------
State | OH
-----------------------------------------------------
Zip | 43085-2289
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 614-436-9404
-----------------------------------------------------
Fax | 614-436-2056
-----------------------------------------------------
=====================================================
Authorized Official
=====================================================
Title or Position | CHIEF EXECUTIVE OFFICER
-----------------------------------------------------
Name | MR. THOMAS J DIMARCO
-----------------------------------------------------
Credential |
-----------------------------------------------------
Telephone | 614-436-9404
-----------------------------------------------------
=====================================================
Scope of Practice (Provider's specialty)
=====================================================
Taxonomy #1
-----------------------------------------------------
Taxonomy Code | 251E00000X
-----------------------------------------------------
Taxonomy Name | Home Health Agency
-----------------------------------------------------
License Number | 517136
-----------------------------------------------------
License Number State | WV
-----------------------------------------------------