Provider Demographics
NPI:1467472886
Name:CITY OF WOOSTER
Entity Type:Organization
Organization Name:CITY OF WOOSTER
Other - Org Name:HOME HEALTH SERVICES - WOOSTER COMMUNITY HOSPITAL
Other - Org Type:Other Name
Authorized Official - Title/Position:DEPARTMENT MANAGER
Authorized Official - Prefix:MRS
Authorized Official - First Name:ALEXSANDRA
Authorized Official - Middle Name:
Authorized Official - Last Name:DAVIS
Authorized Official - Suffix:
Authorized Official - Credentials:RN, BSN, MPA, CPM
Authorized Official - Phone:330-263-8635
Mailing Address - Street 1:1761 BEALL AVE
Mailing Address - Street 2:
Mailing Address - City:WOOSTER
Mailing Address - State:OH
Mailing Address - Zip Code:44691-2342
Mailing Address - Country:US
Mailing Address - Phone:330-263-8636
Mailing Address - Fax:330-263-8541
Practice Address - Street 1:1761 BEALL AVE
Practice Address - Street 2:
Practice Address - City:WOOSTER
Practice Address - State:OH
Practice Address - Zip Code:44691-2342
Practice Address - Country:US
Practice Address - Phone:330-263-8636
Practice Address - Fax:330-263-8541
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-07-20
Last Update Date:2007-09-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes251E00000XAgenciesHome Health
Provider Identifiers
StateIdentifier IDID TypeIssuer
OH0211925Medicaid
OH367624Medicare Oscar/Certification