Provider Demographics
NPI:1508951484
Name:HEALTHQUEST OF AVON, INC.
Entity Type:Organization
Organization Name:HEALTHQUEST OF AVON, INC.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:MRS
Authorized Official - First Name:KRISTY
Authorized Official - Middle Name:ANN
Authorized Official - Last Name:CAIN
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:440-937-4222
Mailing Address - Street 1:33560 DETROIT RD
Mailing Address - Street 2:
Mailing Address - City:AVON
Mailing Address - State:OH
Mailing Address - Zip Code:44011-2030
Mailing Address - Country:US
Mailing Address - Phone:440-937-4222
Mailing Address - Fax:440-967-8715
Practice Address - Street 1:33560 DETROIT RD
Practice Address - Street 2:
Practice Address - City:AVON
Practice Address - State:OH
Practice Address - Zip Code:44011-2030
Practice Address - Country:US
Practice Address - Phone:440-937-4222
Practice Address - Fax:440-967-8715
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-10-04
Last Update Date:2008-06-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OH2074111N00000X
OH3492111N00000X
OH3350111N00000X
OHPT 06257174400000X
OH8647225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes111N00000XChiropractic ProvidersChiropractorGroup - Multi-Specialty
No174400000XOther Service ProvidersSpecialistGroup - Multi-Specialty
No225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical TherapistGroup - Multi-Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
OH2443636Medicaid
OHDA 7565OtherRAILROAD MEDICARE GRP #
OH2441656Medicaid
OH2537642Medicaid
OH2537642Medicaid
OHCR4156051Medicare PIN
OH9338283Medicare PIN
OH2441656Medicaid