Provider Demographics
NPI:1891122354
Name:COMMUNITY HABILITATION SERVICES INC
Entity Type:Organization
Organization Name:COMMUNITY HABILITATION SERVICES INC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:ADMINISTRATOR
Authorized Official - Prefix:MRS
Authorized Official - First Name:WANDA
Authorized Official - Middle Name:
Authorized Official - Last Name:HAINES
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:330-753-3897
Mailing Address - Street 1:PO BOX 1028
Mailing Address - Street 2:
Mailing Address - City:AKRON
Mailing Address - State:OH
Mailing Address - Zip Code:44309-1028
Mailing Address - Country:US
Mailing Address - Phone:330-753-3897
Mailing Address - Fax:330-753-9828
Practice Address - Street 1:1980 BIGELOW ST
Practice Address - Street 2:
Practice Address - City:AKRON
Practice Address - State:OH
Practice Address - Zip Code:44314-2518
Practice Address - Country:US
Practice Address - Phone:330-753-3897
Practice Address - Fax:330-753-9828
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2013-09-30
Last Update Date:2013-09-30
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes320600000XResidential Treatment FacilitiesResidential Treatment Facility, Intellectual and/or Developmental Disabilities
Provider Identifiers
StateIdentifier IDID TypeIssuer
OH7700554Medicaid