Provider Demographics
NPI:1629761408
Name:MIDWEST HEALTH SERVICES, INC.
Entity Type:Organization
Organization Name:MIDWEST HEALTH SERVICES, INC.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:
Authorized Official - First Name:JORDAN
Authorized Official - Middle Name:
Authorized Official - Last Name:KNETZER
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:330-832-9582
Mailing Address - Street 1:107 TOMMY HENRICH DR NW
Mailing Address - Street 2:
Mailing Address - City:MASSILLON
Mailing Address - State:OH
Mailing Address - Zip Code:44647-5402
Mailing Address - Country:US
Mailing Address - Phone:330-353-5715
Mailing Address - Fax:
Practice Address - Street 1:107 TOMMY HENRICH DR NW
Practice Address - Street 2:
Practice Address - City:MASSILLON
Practice Address - State:OH
Practice Address - Zip Code:44647-5402
Practice Address - Country:US
Practice Address - Phone:330-832-9582
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2023-05-30
Last Update Date:2023-05-30
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes251S00000XAgenciesCommunity/Behavioral Health