1285649764 NPI number — HEALTH II OF OHIO, LLC

Table of content: (NPI 1285649764)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1285649764 NPI number — HEALTH II OF OHIO, LLC

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
HEALTH II OF OHIO, LLC
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:
Provider Other Organization Name Type Code:
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:
1285649764
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:
8723 E VIA DE COMMERCIO
Provider Second Line Business Mailing Address:
Provider Business Mailing Address City Name:
SCOTTSDALE
Provider Business Mailing Address State Name:
AZ
Provider Business Mailing Address Postal Code:
85258-3328
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
480-315-8607
Provider Business Mailing Address Fax Number:
480-315-8796

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
1051 TIFFIN AVE
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
FINDLAY
Provider Business Practice Location Address State Name:
OH
Provider Business Practice Location Address Postal Code:
45840-6203
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
419-423-9003
Provider Business Practice Location Address Fax Number:
419-423-8022
Provider Enumeration Date:
07/31/2006

Additional Information

Authorized Official

Authorized Official Last Name:
MATTICE
Authorized Official First Name:
KATHLEEN
Authorized Official Middle Name:
Authorized Official Title or Position:
CHIEF OPERATING OFFICER
Authorized Official Telephone Number:
480-315-8607

Provider Taxonomy Codes

  • Taxonomy code: 332B00000X , with the licence number:  32027037 , registered in the state of OH ; information, associated with the NPI states the following Primary Taxonomy Switch: "X" .
  • Taxonomy code: 332BX2000X , registered in the state of OH ; information, associated with the NPI states the following Primary Taxonomy Switch: "X" .

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

  • Identifier: 81698 . This is a "ABP" identifier , issued by the state of ( OH ) . This identifiers is of the category "OTHER".
  • Identifier: 81700 . This is a "NORTHWOOD" identifier , issued by the state of ( OH ) . This identifiers is of the category "OTHER".
  • Identifier: 000000313645 . This is a "ANTHEM" identifier , issued by the state of ( OH ) . This identifiers is of the category "OTHER".
  • Identifier: 2440326 , issued by the state of ( OH ) . This identifiers is of the category "MEDICAID".
  • Identifier: 2461590 , issued by the state of ( OH ) . This identifiers is of the category "MEDICAID".
  • Identifier: 81698 . This is a "NORTHWOOD" identifier , issued by the state of ( OH ) . This identifiers is of the category "OTHER".
  • Identifier: 3200771 . This is a "ODMRDD" identifier , issued by the state of ( OH ) . This identifiers is of the category "OTHER".
  • Identifier: 23626 . This is a "ABP" identifier , issued by the state of ( OH ) . This identifiers is of the category "OTHER".




Copyright © 2007-2024 www.npivalidator.com