MEDICARE: DEPAD HOME CARE AGENCY INC

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	251E00000X	Home Health Agency

General Provider Information

NPI Number	:	1174357495
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	DEPAD HOME CARE AGENCY INC

Provider Business Mailing Address
First Line	:	4271 WATERFRONT CT
Second Line	:
City	:	FAIRFIELD
State	:	OH
Zip	:	45014-3679
Country	:	US
Telephone Number	:	513-290-8635
Fax Number	:

Provider Business Practice Location Address
First Line	:	4271 WATERFRONT CT
Second Line	:
City	:	FAIRFIELD
State	:	OH
Zip	:	45014-3679
Country	:	US
Telephone Number	:	513-290-8635
Fax Number	:

Authorized Official
Title or Position	:	PRESIDENT
Name	:	ESTELER K NJU
Credential	:	DO
Telephone Number	:	513-290-8635

Provider Enumeration Date	:	08/28/2024
Last Update Date	:	08/28/2024

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