Provider Demographics
NPI:1760899496
Name:MARINCHICK, CALSANDRA A (CCHW)
Entity Type:Individual
Prefix:
First Name:CALSANDRA
Middle Name:A
Last Name:MARINCHICK
Suffix:
Gender:F
Credentials:CCHW
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:630 21ST ST NW
Mailing Address - Street 2:
Mailing Address - City:CANTON
Mailing Address - State:OH
Mailing Address - Zip Code:44709-3869
Mailing Address - Country:US
Mailing Address - Phone:330-309-3341
Mailing Address - Fax:330-437-3717
Practice Address - Street 1:630 21ST ST NW
Practice Address - Street 2:
Practice Address - City:CANTON
Practice Address - State:OH
Practice Address - Zip Code:44709-3869
Practice Address - Country:US
Practice Address - Phone:330-309-3341
Practice Address - Fax:330-437-3717
Is Sole Proprietor?:Yes
Enumeration Date:2014-07-15
Last Update Date:2017-05-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
374U00000X
OHCHW.000462172V00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes172V00000XOther Service ProvidersCommunity Health Worker
No374U00000XNursing Service Related ProvidersHome Health Aide
Provider Identifiers
StateIdentifier IDID TypeIssuer
OH3090980Medicaid