ODH Program Information

Medicare and Medicaid Certification Information

Medicare ID:

Medicaid ID:

Provider Demographics
Address:			Ownership:
			Operator:
County:			Administrator:
Phone Number:			Mailing Address:
Fax Number:
E-mail Address:

Medicare and Medicaid Certification Information
General Certification Information:

Certification Status:			Original Date of Certification:
Last Annual Survey Date:

* A mailing address will appear if it is different from the business address

Enhanced Information Dissemination Version 20.0.1

Software release on: 01/27/2026