Provider Demographics
NPI:1134587108
Name:ADDISON HOME HEALTH SERVICES LLC
Entity type:Organization
Organization Name:ADDISON HOME HEALTH SERVICES LLC
Other - Org Name:<UNAVAIL>
Other - Org Type:
Authorized Official - Title/Position:CEO
Authorized Official - Prefix:MR
Authorized Official - First Name:ISLOM
Authorized Official - Middle Name:
Authorized Official - Last Name:SHAKHBANDAROV
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:888-570-1152
Mailing Address - Street 1:1819 TROY ST STE 3
Mailing Address - Street 2:
Mailing Address - City:DAYTON
Mailing Address - State:OH
Mailing Address - Zip Code:45404-2400
Mailing Address - Country:US
Mailing Address - Phone:888-570-1152
Mailing Address - Fax:937-771-1661
Practice Address - Street 1:1819 TROY ST STE 3
Practice Address - Street 2:
Practice Address - City:DAYTON
Practice Address - State:OH
Practice Address - Zip Code:45404
Practice Address - Country:US
Practice Address - Phone:888-570-1152
Practice Address - Fax:937-771-1661
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2016-02-05
Last Update Date:2019-10-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OH251J00000X, 253Z00000X, 251E00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes251E00000XAgenciesHome Health
No251J00000XAgenciesNursing Care
No253Z00000XAgenciesIn Home Supportive Care