Provider Demographics
NPI:1003270695
Name:PORTAGE CHOICE HOMES LLC
Entity Type:Organization
Organization Name:PORTAGE CHOICE HOMES LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:CEO
Authorized Official - Prefix:
Authorized Official - First Name:KELLY
Authorized Official - Middle Name:
Authorized Official - Last Name:STALNAKER
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:330-993-0185
Mailing Address - Street 1:4799 NEW MILFORD RD
Mailing Address - Street 2:
Mailing Address - City:RAVENNA
Mailing Address - State:OH
Mailing Address - Zip Code:44266-7902
Mailing Address - Country:US
Mailing Address - Phone:330-993-0185
Mailing Address - Fax:
Practice Address - Street 1:4799 NEW MILFORD RD
Practice Address - Street 2:
Practice Address - City:RAVENNA
Practice Address - State:OH
Practice Address - Zip Code:44266-7902
Practice Address - Country:US
Practice Address - Phone:330-993-0185
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2016-04-08
Last Update Date:2016-04-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes251E00000XAgenciesHome Health