Provider Demographics
NPI:1215381397
Name:JASMOND MCCOY
Entity Type:Organization
Organization Name:JASMOND MCCOY
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:INDEPENDENT PROVIDER
Authorized Official - Prefix:
Authorized Official - First Name:JASMOND
Authorized Official - Middle Name:CARIE
Authorized Official - Last Name:MCCOY
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:330-809-3562
Mailing Address - Street 1:1238 WILLARD AVE SE
Mailing Address - Street 2:
Mailing Address - City:WARREN
Mailing Address - State:OH
Mailing Address - Zip Code:44484-4440
Mailing Address - Country:US
Mailing Address - Phone:330-809-3562
Mailing Address - Fax:
Practice Address - Street 1:1238 WILLARD AVE SE
Practice Address - Street 2:
Practice Address - City:WARREN
Practice Address - State:OH
Practice Address - Zip Code:44484-4440
Practice Address - Country:US
Practice Address - Phone:330-809-3562
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2016-04-14
Last Update Date:2016-04-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OHTG441174251E00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes251E00000XAgenciesHome Health