1972507200 NPI number — ASHTABULA REGIONAL HOME HEALTH SERVICES

Table of content: (NPI 1972507200)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1972507200 NPI number — ASHTABULA REGIONAL HOME HEALTH SERVICES

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
ASHTABULA REGIONAL HOME HEALTH SERVICES
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:
ACMC REGIONAL HOME HEALTH
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:
1972507200
Entity Type Code:
Organization
Replacement NPI:
Last Update Date:
01/08/2019
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
PO BOX 1428
Provider Second Line Business Mailing Address:
Provider Business Mailing Address City Name:
ASHTABULA
Provider Business Mailing Address State Name:
OH
Provider Business Mailing Address Postal Code:
44005-1428
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
440-992-4663
Provider Business Mailing Address Fax Number:
440-992-0687

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
2131 LAKE AVE STE 2
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
ASHTABULA
Provider Business Practice Location Address State Name:
OH
Provider Business Practice Location Address Postal Code:
44004-3466
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
440-992-4663
Provider Business Practice Location Address Fax Number:
440-992-0687
Provider Enumeration Date:
06/01/2005

Additional Information

Authorized Official

Authorized Official Last Name:
FOX
Authorized Official First Name:
CONNIE
Authorized Official Middle Name:
Authorized Official Title or Position:
ACCOUNTS SUPERVISOR
Authorized Official Telephone Number:
440-997-6257

Provider Taxonomy Codes

  • Taxonomy code: 251E00000X , with the licence number:  NA , registered in the state of OH ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

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

  • Identifier: 0254479 , issued by the state of ( OH ) . This identifiers is of the category "MEDICAID".




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