Provider Demographics
NPI:1407188469
Name:HEALTH PROFESSIONALS OF HOLMES COUNTY, INC
Entity Type:Organization
Organization Name:HEALTH PROFESSIONALS OF HOLMES COUNTY, INC
Other - Org Name:POMERENE FAMILY CARE
Other - Org Type:Doing Business As
Authorized Official - Title/Position:CHIEF FINANCIAL OFFICER
Authorized Official - Prefix:MR
Authorized Official - First Name:JASON
Authorized Official - Middle Name:
Authorized Official - Last Name:JUSTUS
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:330-674-1015
Mailing Address - Street 1:1261 WOOSTER RD
Mailing Address - Street 2:SUITE 200
Mailing Address - City:MILLERSBURG
Mailing Address - State:OH
Mailing Address - Zip Code:44654-1568
Mailing Address - Country:US
Mailing Address - Phone:330-674-3333
Mailing Address - Fax:330-763-2063
Practice Address - Street 1:126 S BROADWAY ST
Practice Address - Street 2:
Practice Address - City:SUGARCREEK
Practice Address - State:OH
Practice Address - Zip Code:44681-9378
Practice Address - Country:US
Practice Address - Phone:330-852-2504
Practice Address - Fax:330-763-2063
EIN:<UNAVAIL>
Is Organization Subpart?:Yes
Parent Organization LBN:HEALTH PROFESSIONALS OF HOLMES COUNTY, INC
Parent Organization TIN:<UNAVAIL>
Enumeration Date:2010-02-02
Last Update Date:2012-08-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes174400000XOther Service ProvidersSpecialistGroup - Multi-Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
OH2811498Medicaid
OH2811498Medicaid