MEDICARE: OHIO HOMECARE PROGRAM

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	RY914035	OH

General Provider Information

NPI Number	:	1235404666
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	OHIO HOMECARE PROGRAM

Provider Business Mailing Address
First Line	:	232 FERRIS AVE
Second Line	:
City	:	TOLEDO
State	:	OH
Zip	:	43608-1769
Country	:	US
Telephone Number	:	567-225-8629
Fax Number	:

Provider Business Practice Location Address
First Line	:	232 FERRIS AVE
Second Line	:
City	:	TOLEDO
State	:	OH
Zip	:	43608-1769
Country	:	US
Telephone Number	:	567-225-8629
Fax Number	:

Authorized Official
Title or Position	:	HOME HEALTH AIDE
Name	:	KRISTIN LYNN MINKOWSKI
Credential	:	NA
Telephone Number	:	567-225-8629

Provider Enumeration Date	:	03/19/2012
Last Update Date	:	03/19/2012

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Directions to “OHIO HOMECARE PROGRAM ” Practice Location

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