Provider Demographics
NPI:1427220136
Name:ASHTABULA REGIONAL HOME HEALTH SERVICES
Entity Type:Organization
Organization Name:ASHTABULA REGIONAL HOME HEALTH SERVICES
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:EXECUTIVE DIRECTOR
Authorized Official - Prefix:MRS
Authorized Official - First Name:SUE
Authorized Official - Middle Name:
Authorized Official - Last Name:SHADLE
Authorized Official - Suffix:
Authorized Official - Credentials:MSN, RN
Authorized Official - Phone:440-992-4663
Mailing Address - Street 1:PO BOX 1428
Mailing Address - Street 2:
Mailing Address - City:ASHTABULA
Mailing Address - State:OH
Mailing Address - Zip Code:44005-1428
Mailing Address - Country:US
Mailing Address - Phone:440-992-4663
Mailing Address - Fax:440-992-0687
Practice Address - Street 1:3949 JEFFERSON RD
Practice Address - Street 2:
Practice Address - City:ASHTABULA
Practice Address - State:OH
Practice Address - Zip Code:44004-9117
Practice Address - Country:US
Practice Address - Phone:440-992-4663
Practice Address - Fax:440-992-0687
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2008-04-02
Last Update Date:2016-12-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes332B00000XSuppliersDurable Medical Equipment & Medical Supplies
Provider Identifiers
StateIdentifier IDID TypeIssuer
OH0708809Medicaid