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Moicano Healthcare Provider

Debarred entity

Moicano Healthcare Provider is an entity of interest. It has not been found on international sanctions lists.

Type	Company				[sources]
Name	Moicano Healthcare Provider				[sources]
Incorporation date	not available				[sources]
Jurisdiction	not available				[sources]
Country	United States				[sources]
Description	Provider ID: 0103628				[sources]
Registration number	not available				[sources]
Sector	45 - WAIVERED SERVICES ORGANIZATION				[sources]
Address	1116 Hicks Blvd, Fairfield, OH 45014				[sources]
Last change	2025-05-01	Last processed	2025-11-15	First seen	2024-11-12

Sanctions
Country	Authority	Program	Start date	End date
United States	Ohio Department of Medicaid	-	2025-03-18	-

Address
Full address	Country
1116 Hicks Blvd, Fairfield, OH 45014	United States

Medical providers excluded or suspended from Ohio's Medicaid program.

United States · ODM

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