Provider Demographics
NPI:1497849848
Name:NETSOURCE HEALTH SERVICES LTD
Entity Type:Organization
Organization Name:NETSOURCE HEALTH SERVICES LTD
Other - Org Name:SHIRLEY MCINTOSH
Other - Org Type:Other Name
Authorized Official - Title/Position:AGENT
Authorized Official - Prefix:
Authorized Official - First Name:SHIRLEY
Authorized Official - Middle Name:I D
Authorized Official - Last Name:MCINTOSH
Authorized Official - Suffix:
Authorized Official - Credentials:NP
Authorized Official - Phone:330-412-4327
Mailing Address - Street 1:2812 7TH ST NW
Mailing Address - Street 2:
Mailing Address - City:CANTON
Mailing Address - State:OH
Mailing Address - Zip Code:44708-4315
Mailing Address - Country:US
Mailing Address - Phone:330-412-4327
Mailing Address - Fax:
Practice Address - Street 1:2812 7TH ST NW
Practice Address - Street 2:
Practice Address - City:CANTON
Practice Address - State:OH
Practice Address - Zip Code:44708-4315
Practice Address - Country:US
Practice Address - Phone:330-412-4327
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-10-02
Last Update Date:2008-08-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OHCOA.05016-NP251J00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes251J00000XAgenciesNursing Care
Provider Identifiers
StateIdentifier IDID TypeIssuer
OH2341291Medicaid
OHMCNP08214Medicare ID - Type Unspecified
OH2341291Medicaid