Provider Demographics
NPI:1851370647
Name:OLMSTED HEALTH & SERVICES CORP.
Entity Type:Organization
Organization Name:OLMSTED HEALTH & SERVICES CORP.
Other - Org Name:ELIZA JENNINGS SENIOR CARE
Other - Org Type:Doing Business As
Authorized Official - Title/Position:MEDICAL DIRECTOR
Authorized Official - Prefix:
Authorized Official - First Name:MATTHEW
Authorized Official - Middle Name:
Authorized Official - Last Name:WAYNE
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:440-235-7100
Mailing Address - Street 1:PO BOX 246
Mailing Address - Street 2:
Mailing Address - City:NORTH OLMSTED
Mailing Address - State:OH
Mailing Address - Zip Code:44070-0246
Mailing Address - Country:US
Mailing Address - Phone:440-777-6017
Mailing Address - Fax:440-777-6940
Practice Address - Street 1:26376 JOHN RD
Practice Address - Street 2:
Practice Address - City:OLMSTED FALLS
Practice Address - State:OH
Practice Address - Zip Code:44138-1277
Practice Address - Country:US
Practice Address - Phone:440-235-7100
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-01-11
Last Update Date:2020-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207R00000XAllopathic & Osteopathic PhysiciansInternal MedicineGroup - Multi-Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
OH0840068Medicaid
OH0840068Medicaid