Provider Demographics
NPI:1366134207
Name:LIZZY ONE HOME CARE AGENCY LLC
Entity type:Organization
Organization Name:LIZZY ONE HOME CARE AGENCY LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PCT
Authorized Official - Prefix:MR
Authorized Official - First Name:MARTIN
Authorized Official - Middle Name:
Authorized Official - Last Name:KONADU-WIREDU
Authorized Official - Suffix:
Authorized Official - Credentials:PATIENT CARE TECH
Authorized Official - Phone:978-860-6645
Mailing Address - Street 1:7651 HOWELL PARK DR
Mailing Address - Street 2:
Mailing Address - City:PICKERINGTON
Mailing Address - State:OH
Mailing Address - Zip Code:43147-9514
Mailing Address - Country:US
Mailing Address - Phone:978-860-6645
Mailing Address - Fax:
Practice Address - Street 1:7651 HOWELL PARK DR
Practice Address - Street 2:
Practice Address - City:PICKERINGTON
Practice Address - State:OH
Practice Address - Zip Code:43147-9514
Practice Address - Country:US
Practice Address - Phone:978-860-6645
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2023-05-22
Last Update Date:2023-05-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes106S00000XBehavioral Health & Social Service ProvidersBehavior TechnicianGroup - Multi-Specialty