=====================================================
General NPI Number Information
=====================================================
NPI Number | 1790051639
-----------------------------------------------------
Entity Type | Organization
-----------------------------------------------------
Legal Business Name | ASPENHOME HEALTHCARE LLC
-----------------------------------------------------
=====================================================
Dates
=====================================================
Enumeration Date | 03/26/2012
-----------------------------------------------------
Last Update Date | 03/26/2012
-----------------------------------------------------
=====================================================
Provider Practice Location Address
=====================================================
Address Line | 261 W JOHNSTOWN RD
-----------------------------------------------------
City | GAHANNA
-----------------------------------------------------
State | OH
-----------------------------------------------------
Zip | 43230-2732
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 614-475-7773
-----------------------------------------------------
Fax | 614-475-7774
-----------------------------------------------------
=====================================================
Provider Business Mailing Address
=====================================================
Address Line | 261 W JOHNSTOWN RD
-----------------------------------------------------
City | GAHANNA
-----------------------------------------------------
State | OH
-----------------------------------------------------
Zip | 43230-2732
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 614-475-7773
-----------------------------------------------------
Fax | 614-475-7774
-----------------------------------------------------
=====================================================
Authorized Official
=====================================================
Title or Position | OWNER/CEO
-----------------------------------------------------
Name | MR. NEAL EDWARD WENGATZ
-----------------------------------------------------
Credential |
-----------------------------------------------------
Telephone | 614-774-1523
-----------------------------------------------------
=====================================================
Scope of Practice (Provider's specialty)
=====================================================
Taxonomy #1
-----------------------------------------------------
Taxonomy Code | 251E00000X
-----------------------------------------------------
Taxonomy Name | Home Health Agency
-----------------------------------------------------
License Number | OH04761
-----------------------------------------------------
License Number State | OH
-----------------------------------------------------