Provider Demographics
NPI:1023032620
Name:KAISER FOUNDATION HEALTH PLAN OF OHIO
Entity Type:Organization
Organization Name:KAISER FOUNDATION HEALTH PLAN OF OHIO
Other - Org Name:KAISER PERMANENTE HOME CARE AGENCY
Other - Org Type:Doing Business As
Authorized Official - Title/Position:VICE PRESIDENT AND CHIEF FINANCIAL
Authorized Official - Prefix:
Authorized Official - First Name:THOMAS
Authorized Official - Middle Name:R
Authorized Official - Last Name:REVIS
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:216-479-5136
Mailing Address - Street 1:5420 LANCASTER DR
Mailing Address - Street 2:
Mailing Address - City:BROOKLYN HEIGHTS
Mailing Address - State:OH
Mailing Address - Zip Code:44131-1832
Mailing Address - Country:US
Mailing Address - Phone:216-749-8383
Mailing Address - Fax:216-778-6040
Practice Address - Street 1:5420 LANCASTER DR
Practice Address - Street 2:
Practice Address - City:BROOKLYN HEIGHTS
Practice Address - State:OH
Practice Address - Zip Code:44131-1832
Practice Address - Country:US
Practice Address - Phone:216-749-8383
Practice Address - Fax:216-778-6040
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-07-27
Last Update Date:2011-01-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes251E00000XAgenciesHome Health
Provider Identifiers
StateIdentifier IDID TypeIssuer
367574Medicare Oscar/Certification