Provider Demographics
NPI:1790711398
Name:TRI COUNTY HOSPICE
Entity Type:Organization
Organization Name:TRI COUNTY HOSPICE
Other - Org Name:HOSPICE OF WADSWORTH-RITTMAN
Other - Org Type:Doing Business As
Authorized Official - Title/Position:EXECUTIVE DIRECTOR
Authorized Official - Prefix:MR
Authorized Official - First Name:GREG
Authorized Official - Middle Name:
Authorized Official - Last Name:TESNIARZ
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:330-336-6595
Mailing Address - Street 1:102 MAIN ST
Mailing Address - Street 2:SUITE 304
Mailing Address - City:WADSWORTH
Mailing Address - State:OH
Mailing Address - Zip Code:44281-1472
Mailing Address - Country:US
Mailing Address - Phone:330-336-6595
Mailing Address - Fax:330-335-1505
Practice Address - Street 1:102 MAIN ST
Practice Address - Street 2:SUITE 304
Practice Address - City:WADSWORTH
Practice Address - State:OH
Practice Address - Zip Code:44281-1472
Practice Address - Country:US
Practice Address - Phone:330-336-6595
Practice Address - Fax:330-335-1505
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-06-24
Last Update Date:2020-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OH0078HSP251G00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes251G00000XAgenciesHospice Care, Community Based
Provider Identifiers
StateIdentifier IDID TypeIssuer
OH0306743Medicaid
361586Medicare ID - Type UnspecifiedMEDICARE PROVEDER NUMBER