Provider Demographics
NPI:1467685024
Name:INCARE HEALTH AND WELLNESS, NORTHERN OHIO
Entity Type:Organization
Organization Name:INCARE HEALTH AND WELLNESS, NORTHERN OHIO
Other - Org Name:NATL CHURCH RES HOME & COMMUNITY SRVCS NORTHERN OHIO HEALTH & WELLNESS
Other - Org Type:Doing Business As
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:
Authorized Official - First Name:JACCI
Authorized Official - Middle Name:
Authorized Official - Last Name:NICKELL
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:614-451-2151
Mailing Address - Street 1:2335 N BANK DR
Mailing Address - Street 2:
Mailing Address - City:COLUMBUS
Mailing Address - State:OH
Mailing Address - Zip Code:43220-5423
Mailing Address - Country:US
Mailing Address - Phone:614-451-2151
Mailing Address - Fax:614-451-0351
Practice Address - Street 1:207 PORTAGE TRAIL EXTENSION WEST
Practice Address - Street 2:SUITE 100
Practice Address - City:CUYAHOGA FALLS
Practice Address - State:OH
Practice Address - Zip Code:44223
Practice Address - Country:US
Practice Address - Phone:330-945-6950
Practice Address - Fax:330-945-6955
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2009-08-31
Last Update Date:2015-07-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes253Z00000XAgenciesIn Home Supportive Care
Provider Identifiers
StateIdentifier IDID TypeIssuer
243939812OtherPASSPORT