Provider Demographics
NPI:1558654541
Name:NATIONWIDE HEALTH MANAGEMENT LLC
Entity Type:Organization
Organization Name:NATIONWIDE HEALTH MANAGEMENT LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:CEO
Authorized Official - Prefix:MR
Authorized Official - First Name:CHANTHOU
Authorized Official - Middle Name:
Authorized Official - Last Name:PHAY
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:440-888-8888
Mailing Address - Street 1:5700 CHEVROLET BLVD
Mailing Address - Street 2:
Mailing Address - City:PARMA
Mailing Address - State:OH
Mailing Address - Zip Code:44130-1412
Mailing Address - Country:US
Mailing Address - Phone:440-888-8888
Mailing Address - Fax:440-888-8895
Practice Address - Street 1:5700 CHEVROLET BLVD
Practice Address - Street 2:
Practice Address - City:PARMA
Practice Address - State:OH
Practice Address - Zip Code:44130-1412
Practice Address - Country:US
Practice Address - Phone:440-888-8888
Practice Address - Fax:440-888-8895
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2011-05-24
Last Update Date:2016-05-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OH1575441251E00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes251E00000XAgenciesHome Health
Provider Identifiers
StateIdentifier IDID TypeIssuer
OH2650920Medicaid