MEDICARE: BABY BOOMERS HOME HEALTH CARE,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	251E00000X	Home Health Agency		OH

General Provider Information

NPI Number	:	1225413107
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	BABY BOOMERS HOME HEALTH CARE,LLC

Provider Business Mailing Address
First Line	:	5200 CLEVELAND AVE
Second Line	:	SUITE B
City	:	COLUMBUS
State	:	OH
Zip	:	43231-4756
Country	:	US
Telephone Number	:	614-888-1100
Fax Number	:	614-888-1101

Provider Business Practice Location Address
First Line	:	5200 CLEVELAND AVE
Second Line	:	SUITE B
City	:	COLUMBUS
State	:	OH
Zip	:	43231-4756
Country	:	US
Telephone Number	:	614-888-1100
Fax Number	:	614-888-1101

Authorized Official
Title or Position	:	OWNER
Name	:	MR. ABDIRISAK AHMED YUSUF
Credential	:
Telephone Number	:	614-888-1100

Provider Enumeration Date	:	07/21/2015
Last Update Date	:	07/21/2015

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