Provider Demographics
NPI:1053312942
Name:ASSURED HEALTH CARE INC.
Entity Type:Organization
Organization Name:ASSURED HEALTH CARE INC.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:ADMINISTRATOR
Authorized Official - Prefix:MS
Authorized Official - First Name:HOLLY
Authorized Official - Middle Name:
Authorized Official - Last Name:HALL
Authorized Official - Suffix:
Authorized Official - Credentials:RN, MS
Authorized Official - Phone:937-294-2803
Mailing Address - Street 1:1250 W DOROTHY LN
Mailing Address - Street 2:SUITE # 204
Mailing Address - City:DAYTON
Mailing Address - State:OH
Mailing Address - Zip Code:45409-1317
Mailing Address - Country:US
Mailing Address - Phone:937-294-2803
Mailing Address - Fax:937-294-4946
Practice Address - Street 1:1250 W DOROTHY LN
Practice Address - Street 2:SUITE # 204
Practice Address - City:DAYTON
Practice Address - State:OH
Practice Address - Zip Code:45409-1317
Practice Address - Country:US
Practice Address - Phone:937-294-2803
Practice Address - Fax:937-294-4946
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2005-08-02
Last Update Date:2020-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OH251E00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes251E00000XAgenciesHome Health
Provider Identifiers
StateIdentifier IDID TypeIssuer
OH0157100OtherWAIVER
OH0162185Medicaid
OH3600965765OtherCLIA
OH36-7647Medicare ID - Type Unspecified