Provider Demographics
NPI:1467655944
Name:ELIZA JENNINGS SERVICES CORPORATION
Entity Type:Organization
Organization Name:ELIZA JENNINGS SERVICES CORPORATION
Other - Org Name:ELIZA AT HOME
Other - Org Type:Doing Business As
Authorized Official - Title/Position:HOME HEALTH COORDINATOR
Authorized Official - Prefix:
Authorized Official - First Name:BRYCE
Authorized Official - Middle Name:
Authorized Official - Last Name:GRAY
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:440-235-8489
Mailing Address - Street 1:26376 JOHN RD
Mailing Address - Street 2:
Mailing Address - City:OLMSTED TWP
Mailing Address - State:OH
Mailing Address - Zip Code:44138-1277
Mailing Address - Country:US
Mailing Address - Phone:440-235-8592
Mailing Address - Fax:
Practice Address - Street 1:26376 JOHN RD
Practice Address - Street 2:
Practice Address - City:OLMSTED TWP
Practice Address - State:OH
Practice Address - Zip Code:44138-1277
Practice Address - Country:US
Practice Address - Phone:440-235-8592
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:Yes
Parent Organization LBN:ELIZA JENNINGS SENIOR CARE NETWORK
Parent Organization TIN:<UNAVAIL>
Enumeration Date:2007-06-11
Last Update Date:2021-02-24
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes251E00000XAgenciesHome HealthGroup - Single Specialty
No363LA2200XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerAdult HealthGroup - Single Specialty
No363LG0600XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerGerontologyGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
OH0346045Medicaid