1750757589 NPI number — ALPINE HOUSE OF RAVENNA INC

Table of Contents

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1750757589 NPI number — ALPINE HOUSE OF RAVENNA INC

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
ALPINE HOUSE OF RAVENNA 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:
ALPINE HEALTHCARE
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:
1750757589
Entity Type Code:
Organization
Replacement NPI:
Last Update Date:
04/11/2024
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
2402 MISSION HILL DR
Provider Second Line Business Mailing Address:
Provider Business Mailing Address City Name:
PERRYSBURG
Provider Business Mailing Address State Name:
OH
Provider Business Mailing Address Postal Code:
43551-6239
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
330-297-7000
Provider Business Mailing Address Fax Number:

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
7000 STATE ROUTE 88
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
RAVENNA
Provider Business Practice Location Address State Name:
OH
Provider Business Practice Location Address Postal Code:
44266-9188
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
330-297-7000
Provider Business Practice Location Address Fax Number:
Provider Enumeration Date:
08/17/2015

Additional Information

			
		

Authorized Official

Authorized Official Last Name:
WELLS
Authorized Official First Name:
JOSEPH
Authorized Official Middle Name:
K
Authorized Official Title or Position:
CEO
Authorized Official Telephone Number:
419-472-5350

Provider Taxonomy Codes

  • Taxonomy code: 310400000X , with the licence number:  2705R , 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)