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New Provider/Steps to Enrollment/Licensed Practical Nurse

Non-Agency Licensed Practical Nurse

  Requirement   FAQ's
1

Submit your current nursing license number. Please make sure the number can be read for verification purposes.

How do you define current?Current Nursing licensure means a valid nursing license that has not expired, lapsed, been made inactive, terminated, or revoked.
2

You must submit two forms of identification.
1. One must be a copy of your Social Security Card.
2. The other must be a government issued photo ID with your current address on it.

If your ID does not list your current address, you may submit a current utility bill or pay stub that has your current address on it, along with the copy of your ID.

Are credit cards accepted as a form of identification? Credit Cards are not acceptable ID and will not be accepted under any circumstances.
3 You must also provide the name, RN licensure number, address and phone number of her/his potential RN Supervisor.

How can I find a RN Supervisor? Most LPN have known their RN Supervisor before becoming Non-Agency Nurse Providers. It is your responsibility to find your own Supervisor.

4

Submit all the required information to your regional
Ohio Home Care Program office.

Region 1 - Dayton
Ohio Home Care Program
Provider Enrollment Department
81 Rhoads Center Drive
Suite A
Centerville, Ohio 45458
Office 937-435-1161
Toll Free 1-800-538-4218
Region 2 - Columbus
Ohio Home Care Program
Provider Enrollment Department
6100 Channingway Blvd.
Suite 700
Columbus, Ohio 43232
Office 614-751-7777
Toll Free 1-800-616-3718
Region 3 - Canton
Ohio Home Care Program
Provider Enrollment Department
4450 Belden Village Street
Suite 504
Canton, Ohio 44718
Office 330-492-4530
Toll Free 1-800-423-1046
Region 4 - Cleveland
Ohio Home Care Program
Provider Enrollment Department
4141 Rockside Road
Suite 210
Seven Hills, Ohio 44131
Office 216-532-2000
Toll Free 1-800-442-1857

Please make sure that there is a valid phone number and current address on all the documentation being sent. Faxed documentation will not be accepted. After all required documentation is received an application will be sent to you for completion.

How can I find out what region(s) I would apply to become a provider of services?
Click here>>