Momba Home Care Ohio, LLC

Primary specialty

In Home Supportive Care AgencyTaxonomy code 253Z00000X

Legal business name

MOMBA HOME CARE OHIO, LLC

Practice address

4555 Lake Forest Dr Ste 580
Blue Ash, OH 45242-3785

Phone

(513) 776-9840

NPI assigned

Jul 25, 2024

Organization subpart

No

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

Authorized official

Name

Elazar Huisman

Title

Npi Manager

Phone

(404) 418-7484

Specialties & licenses 2

Addresses

Other identifiers 2

Locations

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

{
    "created_epoch": "1721865600000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1788393600000",
    "number": "1881422384",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "400 PERIMETER CENTER TER NE STE 300",
            "city": "ATLANTA",
            "state": "GA",
            "postal_code": "303461201"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "4555 LAKE FOREST DR STE 580",
            "city": "BLUE ASH",
            "state": "OH",
            "postal_code": "452423785",
            "telephone_number": "513-776-9840"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "MOMBA HOME CARE OHIO, LLC",
        "organizational_subpart": "NO",
        "enumeration_date": "2024-07-25",
        "last_updated": "2026-09-03",
        "certification_date": "2026-09-03",
        "status": "A",
        "authorized_official_last_name": "HUISMAN",
        "authorized_official_first_name": "ELAZAR",
        "authorized_official_title_or_position": "NPI MANAGER",
        "authorized_official_telephone_number": "404-418-7484"
    },
    "taxonomies": [
        {
            "code": "251E00000X",
            "taxonomy_group": "",
            "desc": "Home Health",
            "state": null,
            "license": null,
            "primary": false
        },
        {
            "code": "253Z00000X",
            "taxonomy_group": "",
            "desc": "In Home Supportive Care",
            "state": null,
            "license": null,
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "HHA LICENSE",
            "identifier": "3151HHN",
            "state": "OH"
        },
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "0110850",
            "state": "OH"
        }
    ],
    "endpoints": [],
    "other_names": []
}

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• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Sep 3, 2026; 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.