MEDICARE: COMMUNITY MERCY HOME CARE SERVICES OF SPRINGFIELD, LLC

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	251F00000X	Home Infusion Agency	02-1252950	OH

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program

General Provider Information

NPI Number	:	1083832612
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	COMMUNITY MERCY HOME CARE SERVICES OF SPRINGFIELD, LLC

Provider Business Mailing Address
First Line	:	6281 TRI RIDGE BLVD STE 300
Second Line	:
City	:	LOVELAND
State	:	OH
Zip	:	45140-8345
Country	:	US
Telephone Number	:	513-576-8472
Fax Number	:

Provider Business Practice Location Address
First Line	:	9963 CINCINNATI DAYTON RD
Second Line	:
City	:	WEST CHESTER
State	:	OH
Zip	:	45069-3823
Country	:	US
Telephone Number	:	513-942-3095
Fax Number	:	513-942-2846

Authorized Official
Title or Position	:	VP, FINANACE & CFO
Name	:	JACK HAWKINS
Credential	:
Telephone Number	:	513-576-8478

Provider Enumeration Date	:	04/20/2007
Last Update Date	:	07/21/2022

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