MEDICARE: IN HOME HEALTH, 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	207RH0002X	Hospice and Palliative Medicine (Internal Medicine) Physician

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program

General Provider Information

NPI Number	:	1861137689
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	IN HOME HEALTH, LLC

Provider Business Mailing Address
First Line	:	PO BOX 10086
Second Line	:
City	:	TOLEDO
State	:	OH
Zip	:	43699-0086
Country	:	US
Telephone Number	:	567-585-1191
Fax Number	:

Provider Business Practice Location Address
First Line	:	12101 WOODCREST EXECUTIVE DR
Second Line	:
City	:	SAINT LOUIS
State	:	MO
Zip	:	63141-5016
Country	:	US
Telephone Number	:	314-453-0990
Fax Number	:

Authorized Official
Title or Position	:	SOLE DIRECTOR
Name	:	MARTIN DAVID ALLEN
Credential	:
Telephone Number	:	419-252-5734

Provider Enumeration Date	:	05/05/2022
Last Update Date	:	05/05/2022

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