Provider Demographics
NPI:1629665377
Name:RICHARD CAMPBELL
Entity Type:Organization
Organization Name:RICHARD CAMPBELL
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:ADMINISTRATOR
Authorized Official - Prefix:
Authorized Official - First Name:MICHELLE
Authorized Official - Middle Name:
Authorized Official - Last Name:COOPERIDER
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:740-438-6962
Mailing Address - Street 1:PO BOX 236
Mailing Address - Street 2:
Mailing Address - City:LANCASTER
Mailing Address - State:OH
Mailing Address - Zip Code:43130-0236
Mailing Address - Country:US
Mailing Address - Phone:740-438-6962
Mailing Address - Fax:
Practice Address - Street 1:3500 COUNTRY CLUB RD SW
Practice Address - Street 2:
Practice Address - City:LANCASTER
Practice Address - State:OH
Practice Address - Zip Code:43130-8585
Practice Address - Country:US
Practice Address - Phone:404-386-9627
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2020-12-29
Last Update Date:2020-12-29
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes253Z00000XAgenciesIn Home Supportive Care
No347C00000XTransportation ServicesPrivate Vehicle