Provider Demographics
NPI:1164145785
Name:TRI STATE HEALTH SERVICES
Entity Type:Organization
Organization Name:TRI STATE HEALTH SERVICES
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:MANAGER, SENIOR ADULT SERVICES
Authorized Official - Prefix:
Authorized Official - First Name:TRUDY
Authorized Official - Middle Name:
Authorized Official - Last Name:WILSON
Authorized Official - Suffix:
Authorized Official - Credentials:MBA
Authorized Official - Phone:740-314-5197
Mailing Address - Street 1:300 LOVERS LN
Mailing Address - Street 2:
Mailing Address - City:STEUBENVILLE
Mailing Address - State:OH
Mailing Address - Zip Code:43953-3448
Mailing Address - Country:US
Mailing Address - Phone:740-314-5197
Mailing Address - Fax:740-314-5772
Practice Address - Street 1:300 LOVERS LN
Practice Address - Street 2:
Practice Address - City:STEUBENVILLE
Practice Address - State:OH
Practice Address - Zip Code:43953-3448
Practice Address - Country:US
Practice Address - Phone:740-314-5197
Practice Address - Fax:740-314-5772
EIN:<UNAVAIL>
Is Organization Subpart?:Yes
Parent Organization LBN:TRI STATE HEALTH SERVICES
Parent Organization TIN:<UNAVAIL>
Enumeration Date:2022-09-20
Last Update Date:2022-09-26
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes332U00000XSuppliersHome Delivered Meals
No343900000XTransportation ServicesNon-emergency Medical Transport (VAN)
Provider Identifiers
StateIdentifier IDID TypeIssuer
OH2246279-OHMedicaid
OHMEDICAIDMedicaid