Provider Demographics
NPI:1114180387
Name:SUMMIT ACRES HOME CARE
Entity Type:Organization
Organization Name:SUMMIT ACRES HOME CARE
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:ADMINISTRATOR
Authorized Official - Prefix:
Authorized Official - First Name:DONALD
Authorized Official - Middle Name:J
Authorized Official - Last Name:CROCK
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:740-732-5712
Mailing Address - Street 1:39 SUMMIT CT
Mailing Address - Street 2:
Mailing Address - City:CALDWELL
Mailing Address - State:OH
Mailing Address - Zip Code:43724-9033
Mailing Address - Country:US
Mailing Address - Phone:740-732-5712
Mailing Address - Fax:740-732-7350
Practice Address - Street 1:39 SUMMIT CT
Practice Address - Street 2:
Practice Address - City:CALDWELL
Practice Address - State:OH
Practice Address - Zip Code:43724-9033
Practice Address - Country:US
Practice Address - Phone:740-732-5712
Practice Address - Fax:740-732-7350
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2008-07-08
Last Update Date:2008-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OH251E00000X, 332BP3500X, 343900000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes251E00000XAgenciesHome Health
No332BP3500XSuppliersDurable Medical Equipment & Medical SuppliesParenteral & Enteral Nutrition
No343900000XTransportation ServicesNon-emergency Medical Transport (VAN)
Provider Identifiers
StateIdentifier IDID TypeIssuer
OH0183813Medicaid
OH0183813Medicaid