1649254608 NPI number — AHF CENTRAL STATES, INC

Table of content: (NPI 1649254608)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1649254608 NPI number — AHF CENTRAL STATES, INC

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
AHF CENTRAL STATES, INC
Provider Last Name:
Provider First Name:
Provider Middle Name:
Provider Name Prefix Text:
Provider Name Suffix Text:
Provider Credential Text:
Provider Gender Code:

Provider's Other Name Information

Provider Other Organization Name:
BELCOURT TERRACE
Provider Other Organization Name Type Code:
3
Provider Other Last Name:
Provider Other First Name:
Provider Other Middle Name:
Provider Other Name Prefix Text:
Provider Other Name Suffix Text:
Provider Other Credential Text:
Provider Other Last Name Type Code:

NPI Number Information

NPI Number:
1649254608
Entity Type Code:
Organization
Replacement NPI:
Last Update Date:
08/22/2020
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
4248 TULLER RD
Provider Second Line Business Mailing Address:
Provider Business Mailing Address City Name:
DUBLIN
Provider Business Mailing Address State Name:
OH
Provider Business Mailing Address Postal Code:
43017-5025
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
614-760-7352
Provider Business Mailing Address Fax Number:
614-760-7356

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
1710 BELCOURT AVE
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
NASHVILLE
Provider Business Practice Location Address State Name:
TN
Provider Business Practice Location Address Postal Code:
37212-3717
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
615-383-3570
Provider Business Practice Location Address Fax Number:
615-460-7778
Provider Enumeration Date:
12/02/2005

Additional Information

Authorized Official

Authorized Official Last Name:
HAEMMERLE
Authorized Official First Name:
MARK
Authorized Official Middle Name:
T
Authorized Official Title or Position:
PRESIDENT
Authorized Official Telephone Number:
614-760-7352

Provider Taxonomy Codes

  • Taxonomy code: 314000000X , with the licence number:  17940 , registered in the state of TN ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

Other Provider's Identifiers (legacy, non-NPI)

  • Identifier: 740011 , issued by the state of ( TN ) . This identifiers is of the category "MEDICAID".
  • Identifier: 445273 , issued by the state of ( KY ) . This identifiers is of the category "MEDICAID".




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