Provider Demographics
NPI:1003074774
Name:ASSURITY HOME HEALTH PASSPORT SERVICES, LLC
Entity Type:Organization
Organization Name:ASSURITY HOME HEALTH PASSPORT SERVICES, LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:CEO
Authorized Official - Prefix:MR
Authorized Official - First Name:KENNETH
Authorized Official - Middle Name:LEE
Authorized Official - Last Name:MOREHOUSE
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:740-384-9616
Mailing Address - Street 1:107 S OHIO AVE
Mailing Address - Street 2:
Mailing Address - City:WELLSTON
Mailing Address - State:OH
Mailing Address - Zip Code:45692-1241
Mailing Address - Country:US
Mailing Address - Phone:740-384-9616
Mailing Address - Fax:740-384-9617
Practice Address - Street 1:107 S OHIO AVE
Practice Address - Street 2:
Practice Address - City:WELLSTON
Practice Address - State:OH
Practice Address - Zip Code:45692-1241
Practice Address - Country:US
Practice Address - Phone:740-384-9616
Practice Address - Fax:740-384-9617
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2008-05-29
Last Update Date:2008-05-29
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OH251E00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes251E00000XAgenciesHome Health