MEDICARE: COMFORT HAVEN HOMECARE, 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	:	1356852768
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	COMFORT HAVEN HOMECARE, LLC

Provider Business Mailing Address
First Line	:	5914 HAMPTON CV
Second Line	:
City	:	WESTERVILLE
State	:	OH
Zip	:	43081-8875
Country	:	US
Telephone Number	:	614-285-9121
Fax Number	:

Provider Business Practice Location Address
First Line	:	5914 HAMPTON CV
Second Line	:
City	:	WESTERVILLE
State	:	OH
Zip	:	43081-8875
Country	:	US
Telephone Number	:	614-285-9121
Fax Number	:

Authorized Official
Title or Position	:	CEO
Name	:	ADETUNJI OLUFEMI OYELEKE
Credential	:
Telephone Number	:	614-285-9121

Provider Enumeration Date	:	10/12/2017
Last Update Date	:	10/12/2017

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