Provider Demographics
NPI:1043533524
Name:GREAT HOME HEALTHCARE, LLC
Entity type:Organization
Organization Name:GREAT HOME HEALTHCARE, LLC
Other - Org Name:<UNAVAIL>
Other - Org Type:
Authorized Official - Title/Position:ADMINISTRATOR
Authorized Official - Prefix:
Authorized Official - First Name:KHADRA
Authorized Official - Middle Name:
Authorized Official - Last Name:JAMA
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:614-475-4026
Mailing Address - Street 1:2999 E DUBLIN GRANVILLE RD STE 215
Mailing Address - Street 2:
Mailing Address - City:COLUMBUS
Mailing Address - State:OH
Mailing Address - Zip Code:43231-4030
Mailing Address - Country:US
Mailing Address - Phone:614-475-4026
Mailing Address - Fax:614-475-4238
Practice Address - Street 1:2999 E DUBLIN GRANVILLE RD STE 215
Practice Address - Street 2:
Practice Address - City:COLUMBUS
Practice Address - State:OH
Practice Address - Zip Code:43231-4030
Practice Address - Country:US
Practice Address - Phone:614-475-4026
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2010-03-11
Last Update Date:2022-03-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes251E00000XAgenciesHome Health
Provider Identifiers
StateIdentifier IDID TypeIssuer
OH0092606Medicaid