Provider Demographics
NPI:1235142001
Name:SACRED ARMS, INC.
Entity Type:Organization
Organization Name:SACRED ARMS, INC.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:CEO/PRESIDENT
Authorized Official - Prefix:MR
Authorized Official - First Name:RICHARD
Authorized Official - Middle Name:E
Authorized Official - Last Name:YARWOOD
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:330-482-3100
Mailing Address - Street 1:8600 GLENWOOD AVE STE 140
Mailing Address - Street 2:
Mailing Address - City:BOARDMAN
Mailing Address - State:OH
Mailing Address - Zip Code:44512-6565
Mailing Address - Country:US
Mailing Address - Phone:330-482-3100
Mailing Address - Fax:330-482-3267
Practice Address - Street 1:8600 GLENWOOD AVE STE 140
Practice Address - Street 2:
Practice Address - City:BOARDMAN
Practice Address - State:OH
Practice Address - Zip Code:44512-6565
Practice Address - Country:US
Practice Address - Phone:330-482-3100
Practice Address - Fax:330-482-3267
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-08-14
Last Update Date:2017-11-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OH36-8133251E00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes251E00000XAgenciesHome Health
Provider Identifiers
StateIdentifier IDID TypeIssuer
OH2142425Medicaid
OH3101468OtherMEDICAID/MRDD
OH2291514OtherPASSPORT
OH2645963OtherCARESTAR
OH368133Medicare Oscar/Certification