Provider Demographics
NPI:1659891760
Name:ACTIVATE HEALTHCARE-OHIO
Entity Type:Organization
Organization Name:ACTIVATE HEALTHCARE-OHIO
Other - Org Name:ACTIVATE HEALTHCARE-LOCAL 392
Other - Org Type:Doing Business As
Authorized Official - Title/Position:PRINCIPAL
Authorized Official - Prefix:
Authorized Official - First Name:DEBRA
Authorized Official - Middle Name:
Authorized Official - Last Name:GEIHSLER
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:773-704-7002
Mailing Address - Street 1:2157 N DAMEN AVE
Mailing Address - Street 2:
Mailing Address - City:CHICAGO
Mailing Address - State:IL
Mailing Address - Zip Code:60647-6916
Mailing Address - Country:US
Mailing Address - Phone:773-967-3144
Mailing Address - Fax:872-808-2119
Practice Address - Street 1:600 RODEO DR
Practice Address - Street 2:
Practice Address - City:ERLANGER
Practice Address - State:KY
Practice Address - Zip Code:41018-1279
Practice Address - Country:US
Practice Address - Phone:859-342-0901
Practice Address - Fax:859-342-0919
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2017-06-21
Last Update Date:2020-06-29
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QH0100XAmbulatory Health Care FacilitiesClinic/CenterHealth Service