Provider Demographics
NPI:1356671432
Name:CLASSIC HEALTH CARE SERVICES, LLC
Entity Type:Organization
Organization Name:CLASSIC HEALTH CARE SERVICES, LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:COORDINATOR
Authorized Official - Prefix:MR
Authorized Official - First Name:ROBERT
Authorized Official - Middle Name:
Authorized Official - Last Name:FOSNAUGH
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:614-848-3900
Mailing Address - Street 1:788 BUSCH CT
Mailing Address - Street 2:
Mailing Address - City:COLUMBUS
Mailing Address - State:OH
Mailing Address - Zip Code:43229-1704
Mailing Address - Country:US
Mailing Address - Phone:614-848-3900
Mailing Address - Fax:614-848-3901
Practice Address - Street 1:788 BUSCH CT
Practice Address - Street 2:
Practice Address - City:COLUMBUS
Practice Address - State:OH
Practice Address - Zip Code:43229-1704
Practice Address - Country:US
Practice Address - Phone:614-848-3900
Practice Address - Fax:614-848-3901
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2010-01-12
Last Update Date:2010-04-29
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes251E00000XAgenciesHome Health
Provider Identifiers
StateIdentifier IDID TypeIssuer
OH2939306OtherODJFS MEDICAID PROVIDER NUMBER