1023289204 NPI number — HEALTH PROFESSIONALS OF HOLMES COUNTY, INC

Table of content: (NPI 1023289204)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1023289204 NPI number — HEALTH PROFESSIONALS OF HOLMES COUNTY, INC

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
HEALTH PROFESSIONALS OF HOLMES COUNTY, 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:
POMERENE FAMILY CARE
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:
1023289204
Entity Type Code:
Organization
Replacement NPI:
Last Update Date:
07/10/2017
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
981 WOOSTER RD
Provider Second Line Business Mailing Address:
Provider Business Mailing Address City Name:
MILLERSBURG
Provider Business Mailing Address State Name:
OH
Provider Business Mailing Address Postal Code:
44654-1536
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
330-674-1584
Provider Business Mailing Address Fax Number:
330-763-2063

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
4606 TOWNSHIP ROAD 634
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
MT. HOPE
Provider Business Practice Location Address State Name:
OH
Provider Business Practice Location Address Postal Code:
44660
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
330-674-4711
Provider Business Practice Location Address Fax Number:
330-674-3320
Provider Enumeration Date:
03/17/2008

Additional Information

Authorized Official

Authorized Official Last Name:
JUSTUS
Authorized Official First Name:
JASON
Authorized Official Middle Name:
Authorized Official Title or Position:
CHIEF FINANCIAL OFFICER
Authorized Official Telephone Number:
330-674-1015

Provider Taxonomy Codes

  • Taxonomy code: 174400000X ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

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





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