Provider Demographics
NPI:1952457988
Name:EASTER SEALS OF MAHONING TRUMBULL & COLUMBIANA COUNTIES
Entity Type:Organization
Organization Name:EASTER SEALS OF MAHONING TRUMBULL & COLUMBIANA COUNTIES
Other - Org Name:EASTER SEALS
Other - Org Type:Doing Business As
Authorized Official - Title/Position:CEO
Authorized Official - Prefix:MRS
Authorized Official - First Name:JODY
Authorized Official - Middle Name:
Authorized Official - Last Name:KLASE
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:330-743-1168
Mailing Address - Street 1:299 EDWARDS ST
Mailing Address - Street 2:
Mailing Address - City:YOUNGSTOWN
Mailing Address - State:OH
Mailing Address - Zip Code:44502-1504
Mailing Address - Country:US
Mailing Address - Phone:330-743-1168
Mailing Address - Fax:330-743-1616
Practice Address - Street 1:299 EDWARDS ST
Practice Address - Street 2:
Practice Address - City:YOUNGSTOWN
Practice Address - State:OH
Practice Address - Zip Code:44502-1504
Practice Address - Country:US
Practice Address - Phone:330-743-1168
Practice Address - Fax:330-743-1616
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-01-25
Last Update Date:2024-01-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OH225100000X, 225X00000X, 235Z00000X
261QA0600X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes261QA0600XAmbulatory Health Care FacilitiesClinic/CenterAdult Day CareGroup - Multi-Specialty
No225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical TherapistGroup - Multi-Specialty
No225X00000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersOccupational TherapistGroup - Multi-Specialty
No235Z00000XSpeech, Language and Hearing Service ProvidersSpeech-Language PathologistGroup - Multi-Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
OH2511348Medicaid
OH0078348Medicaid