1639327760 NPI number — REM OHIO, 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 1639327760 NPI number — REM OHIO, INC

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
REM OHIO, 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:
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:
1639327760
Entity Type Code:
Organization
Replacement NPI:
Last Update Date:
04/20/2023
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
470 PORTAGE LAKES DR STE 206
Provider Second Line Business Mailing Address:
Provider Business Mailing Address City Name:
COVENTRY TOWNSHIP
Provider Business Mailing Address State Name:
OH
Provider Business Mailing Address Postal Code:
44319-2296
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
330-644-5216
Provider Business Mailing Address Fax Number:
330-644-5475

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
2165 RAINBOW DR NW
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
LANCASTER
Provider Business Practice Location Address State Name:
OH
Provider Business Practice Location Address Postal Code:
43130-8523
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
614-367-1370
Provider Business Practice Location Address Fax Number:
614-367-9751
Provider Enumeration Date:
09/03/2008

Additional Information

Authorized Official

Authorized Official Last Name:
COHEN
Authorized Official First Name:
BRETT
Authorized Official Middle Name:
IAN
Authorized Official Title or Position:
COO
Authorized Official Telephone Number:
800-388-5150

Provider Taxonomy Codes

  • Taxonomy code: 320600000X , with the licence number:  0840077 , 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: 0840077 , issued by the state of ( OH ) . This identifiers is of the category "MEDICAID".
  • Identifier: 36-G413 . This is a "CMS CERTIFICATION NUMBER" identifier , issued by the state of ( OH ) . This identifiers is of the category "OTHER".




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