Moicano Healthcare Provider LLC

Primary specialty

Home Health AgencyTaxonomy code 251E00000X

License

2264980 Issued in OH

Legal business name

MOICANO HEALTHCARE PROVIDER LLC

Practice address

260 Northland Blvd Ste 320
Springdale, OH 45246-4921

Phone

(513) 580-3109

Fax

(513) 818-9594

NPI assigned

Nov 10, 2014

Organization subpart

No

Registry information is reported by the provider to CMS and is not verified. About this source

Authorized official

Name

Dr. Caleb N Lola I, DODD

Title

Ceo

Phone

(800) 617-6733

Specialties & licenses 1

Addresses

Other identifiers 1

Other names 1

• moicano healthcare provider llc Former legal business name

Tax ID family

Moicano Health Care2 organizations share this tax ID, including this one

Other organizations with this tax ID 1

Organizations that report the same tax identification number in the National Provider Directory.

• Moicano Health Care Provider.

  • Home Health Agency
  • Springdale, OH
  • NPI 1043689276
  NPD tax ID

Locations

The complete NPPES record for this NPI in the NPI Registry API format.

{
    "created_epoch": "1415577600000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1455062400000",
    "number": "1275939811",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "260 NORTHLAND BLVD STE 320",
            "city": "SPRINGDALE",
            "state": "OH",
            "postal_code": "452464921",
            "telephone_number": "513-580-3109",
            "fax_number": "513-818-9594"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "260 NORTHLAND BLVD STE 320",
            "city": "SPRINGDALE",
            "state": "OH",
            "postal_code": "452464921",
            "telephone_number": "513-580-3109",
            "fax_number": "513-818-9594"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "MOICANO HEALTHCARE PROVIDER LLC",
        "organizational_subpart": "NO",
        "enumeration_date": "2014-11-10",
        "last_updated": "2016-02-10",
        "status": "A",
        "authorized_official_last_name": "LOLA",
        "authorized_official_first_name": "CALEB",
        "authorized_official_middle_name": "N",
        "authorized_official_title_or_position": "CEO",
        "authorized_official_telephone_number": "18006176733",
        "authorized_official_name_prefix": "Dr.",
        "authorized_official_name_suffix": "I",
        "authorized_official_credential": "DODD"
    },
    "taxonomies": [
        {
            "code": "251E00000X",
            "taxonomy_group": "",
            "desc": "Home Health",
            "state": "OH",
            "license": "2264980",
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "0103628",
            "state": "OH"
        }
    ],
    "endpoints": [],
    "other_names": [
        {
            "organization_name": "moicano healthcare provider llc",
            "code": "4",
            "type": "Former Legal Business Name"
        }
    ]
}

• Alyssa Lauren McQueen, PHARMD
• Donnaejah McRae, BSW
• Tara Menkhaus, PHARMD
• Dale Meyer
• Moicano Health Care Provider.
• Mary Morrissey, RDN, LD, CDE
• Cameron D Mundon
• National Vision, Inc.
• Necco, LLC
• Tam Nguyen, PHARM D

• Home Health Agency in Springdale, OH
• Providers in Springdale, OH by specialty
• Home Health Agency in Ohio

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Feb 10, 2016; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
• National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.