Provider Demographics
NPI:1639723067
Name:UMHOLTZ, JUSTIN (CASE MANAGER)
Entity Type:Individual
Prefix:
First Name:JUSTIN
Middle Name:
Last Name:UMHOLTZ
Suffix:
Gender:M
Credentials:CASE MANAGER
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:9600 OLD STATE RD
Mailing Address - Street 2:
Mailing Address - City:CHARDON
Mailing Address - State:OH
Mailing Address - Zip Code:44024-9260
Mailing Address - Country:US
Mailing Address - Phone:859-652-2771
Mailing Address - Fax:
Practice Address - Street 1:9600 OLD STATE RD
Practice Address - Street 2:
Practice Address - City:CHARDON
Practice Address - State:OH
Practice Address - Zip Code:44024-9260
Practice Address - Country:US
Practice Address - Phone:859-652-2771
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2019-07-24
Last Update Date:2019-07-24
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes171M00000XOther Service ProvidersCase Manager/Care Coordinator