Provider Demographics
NPI:1558857060
Name:THOMAS, QUANTINA LOUISE
Entity Type:Individual
Prefix:MISS
First Name:QUANTINA
Middle Name:LOUISE
Last Name:THOMAS
Suffix:
Gender:F
Credentials:
Other - Prefix:MISS
Other - First Name:QUANTINA
Other - Middle Name:LOUISE
Other - Last Name:THOMAS
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:1548 OAK KNOLL AVE SE
Mailing Address - Street 2:
Mailing Address - City:WARREN
Mailing Address - State:OH
Mailing Address - Zip Code:44484-4953
Mailing Address - Country:US
Mailing Address - Phone:330-553-1526
Mailing Address - Fax:
Practice Address - Street 1:1548OAK KNOLL SE
Practice Address - Street 2:
Practice Address - City:WARREN
Practice Address - State:OH
Practice Address - Zip Code:44484
Practice Address - Country:US
Practice Address - Phone:330-330-5875
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2018-07-09
Last Update Date:2018-07-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes251E00000XAgenciesHome HealthGroup - Single Specialty
No374U00000XNursing Service Related ProvidersHome Health AideGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
OH$$$$$$$$$Medicaid