Provider Demographics
NPI:1942733019
Name:ATHENA THERAPY HOLDING CO
Entity Type:Organization
Organization Name:ATHENA THERAPY HOLDING CO
Other - Org Name:ATHENA THERAPY
Other - Org Type:Doing Business As
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:
Authorized Official - First Name:TERESA
Authorized Official - Middle Name:
Authorized Official - Last Name:BRADFORD
Authorized Official - Suffix:
Authorized Official - Credentials:RN
Authorized Official - Phone:330-410-3982
Mailing Address - Street 1:4293 COLUMBIA RD
Mailing Address - Street 2:
Mailing Address - City:MEDINA
Mailing Address - State:OH
Mailing Address - Zip Code:44256-7707
Mailing Address - Country:US
Mailing Address - Phone:330-410-3982
Mailing Address - Fax:330-451-5711
Practice Address - Street 1:260 NILES CORTLAND RD NE
Practice Address - Street 2:
Practice Address - City:WARREN
Practice Address - State:OH
Practice Address - Zip Code:44484-1938
Practice Address - Country:US
Practice Address - Phone:330-609-5791
Practice Address - Fax:330-451-5711
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2017-04-06
Last Update Date:2019-02-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QR0400XAmbulatory Health Care FacilitiesClinic/CenterRehabilitation