Provider Demographics
NPI:1043689276
Name:MOICANO HEALTH CARE PROVIDER.
Entity type:Organization
Organization Name:MOICANO HEALTH CARE PROVIDER.
Other - Org Name:<UNAVAIL>
Other - Org Type:
Authorized Official - Title/Position:CEO
Authorized Official - Prefix:MR
Authorized Official - First Name:CALEB
Authorized Official - Middle Name:N
Authorized Official - Last Name:LOLA
Authorized Official - Suffix:I
Authorized Official - Credentials:MD
Authorized Official - Phone:513-580-3109
Mailing Address - Street 1:230 NORTHLAND BLVD STE 328
Mailing Address - Street 2:
Mailing Address - City:SPRINGDALE
Mailing Address - State:OH
Mailing Address - Zip Code:45246-3694
Mailing Address - Country:US
Mailing Address - Phone:513-818-9594
Mailing Address - Fax:513-818-9594
Practice Address - Street 1:230 NORTHLAND BLVD STE 328
Practice Address - Street 2:
Practice Address - City:SPRINGDALE
Practice Address - State:OH
Practice Address - Zip Code:45246-3694
Practice Address - Country:US
Practice Address - Phone:513-818-9594
Practice Address - Fax:513-818-9594
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2015-09-17
Last Update Date:2015-09-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes251E00000XAgenciesHome Health
Provider Identifiers
StateIdentifier IDID TypeIssuer
OH0103628Medicaid