Southwest Ohio Home Care LLC
Organization Active NPI Home Health Agency · Brookville, OH
NPI 1992495865 · NPPES record last updated Oct 17, 2024
Key facts
- NPI
- 1992495865
- Entity type
- Organization (NPI type 2)
- Primary specialty
- Home Health Agency 251E00000X
- Legal business name
- SOUTHWEST OHIO HOME CARE LLC
- Practice address
- 5624 Heckathorn Rd
Brookville, OH 45309-8305 - Phone
- (937) 913-4314
- Fax
- (937) 870-1323
- NPI assigned
- May 12, 2023
- Organization subpart
- No
Authorized official
- Name
- Erin M Davenport, LPN
- Title
- Adon
- Phone
- (937) 913-4314
Change of ownership 1
Practitioners 1
-
Erin M Davenport, LPN
Medicare Care Compare: Home health agency
- Listed as
- Southwest Ohio Home Care LLC
- Ownership
- Proprietary
- Certified
- Jan 24, 2001
- Medicare certification status
- Active
- Services
- Nursing, Medical social, Home health aide, Physical therapy, Occupational therapy
Laboratory certificates & supplier records
CLIA laboratory certificates
| CLIA number | Laboratory | Certificate | Expires |
|---|---|---|---|
| 36D0977888 | Southwest Ohio Home Care, LLC | Certificate of waiver | Sep 10, 2026 |
Medicare participation
- Medicare fee-for-service enrollment
- Enrolled in OH
Home health agency certification: CCN 367775
- Legal name
- SOUTHWEST OHIO HOME CARE LLC
- Certification status
- Active
- Provider type (POS)
- Home health agency
- Participating since
- Jan 24, 2001
- Last certification
- Jun 13, 2014
- Ownership / control type
- Proprietary
- Most recent change of ownership
- May 31, 2023
- Organization structure
- LLC · Proprietary
- Incorporated
- Mar 24, 2023 in OH
- Enrollment address
- 5624 Heckathorn Rd
Brookville, OH 45309-8305
All disclosed owners & managing parties 1
| Name | Role | Since | Share |
|---|---|---|---|
| Erin Davenport |
5% Or Greater Direct Ownership Interest | May 31, 2023 | 100% |
| W-2 Managing Employee |
May 31, 2023 |
Change-of-ownership history
| Date | Event | Counterparty |
|---|---|---|
| May 31, 2023 | Change of Ownership |
Compass Home Care |
Medicare enrollment records
| Enrollment ID | State | Provider type | PAC ID | Details |
|---|---|---|---|---|
| O20230919004456 | OH | Part a Provider - Home Health Agency | 2769846039 | Practice locations: Brookville, OH |
National Provider Directory
Specialties & licenses
| Specialty (taxonomy) | Code | License | State | Primary |
|---|---|---|---|---|
| Home Health Agency | 251E00000X | Yes |
Addresses
Primary practice location
5624 Heckathorn Rd
Brookville, OH 45309-8305
Mailing address
5624 Heckathorn Rd
Brookville, OH 45309-8305
Phone (937) 913-4314
Other providers in Brookville, OH
- Anthony H Shaffer
- Randall R Shaffer
- Tonya Lynn Singleton
- Melissa Dawn Slack
- Deborah Dawn Smith
- Brian Keith Stinson Jr.
- Studebaker Family Practice Inc.
- Jeffrey Bruce Studebaker
- Vanessa Gayle Taylor
- Transitions Counseling & Wellness, LLC
All providers in Brookville, OH · Home Health Agency in Ohio
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Record last updated by the provider on Oct 17, 2024. Information in NPPES is self-reported and not verified by CMS.
- NUCC Health Care Provider Taxonomy: specialty names.
- Medicare Fee-For-Service Public Provider Enrollment (CMS/PECOS): enrollments, PAC IDs and benefit reassignments.
- CMS facility enrollments, All Owners and change-of-ownership files: CCNs, owners and managing parties.
- Provider of Services files (CMS): certification status, beds and related CCNs.
- Medicare Care Compare provider data (CMS): clinician profile, group practices, facility affiliations, MIPS scores and star ratings.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.