MEDICARE: ST. MARY'S HOME HEALTH CARE

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	:	1205038999
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	ST. MARY'S HOME HEALTH CARE

Provider Business Mailing Address
First Line	:	128 HALDY AVE
Second Line	:
City	:	COLUMBUS
State	:	OH
Zip	:	43204-2658
Country	:	US
Telephone Number	:	614-493-2563
Fax Number	:

Provider Business Practice Location Address
First Line	:	128 HALDY AVE
Second Line	:
City	:	COLUMBUS
State	:	OH
Zip	:	43204-2658
Country	:	US
Telephone Number	:	614-493-2563
Fax Number	:

Authorized Official
Title or Position	:	OWNER
Name	:	MR. RICHARD LEE AMON
Credential	:
Telephone Number	:	614-598-8203

Provider Enumeration Date	:	06/04/2007
Last Update Date	:	08/22/2020

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