Provider Demographics
NPI:1972507200
Name:ASHTABULA REGIONAL HOME HEALTH SERVICES
Entity Type:Organization
Organization Name:ASHTABULA REGIONAL HOME HEALTH SERVICES
Other - Org Name:ACMC REGIONAL HOME HEALTH
Other - Org Type:Doing Business As
Authorized Official - Title/Position:ACCOUNTS SUPERVISOR
Authorized Official - Prefix:
Authorized Official - First Name:CONNIE
Authorized Official - Middle Name:
Authorized Official - Last Name:FOX
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:440-997-6257
Mailing Address - Street 1:PO BOX 1428
Mailing Address - Street 2:
Mailing Address - City:ASHTABULA
Mailing Address - State:OH
Mailing Address - Zip Code:44005-1428
Mailing Address - Country:US
Mailing Address - Phone:440-992-4663
Mailing Address - Fax:440-992-0687
Practice Address - Street 1:2131 LAKE AVE STE 2
Practice Address - Street 2:
Practice Address - City:ASHTABULA
Practice Address - State:OH
Practice Address - Zip Code:44004-3466
Practice Address - Country:US
Practice Address - Phone:440-992-4663
Practice Address - Fax:440-992-0687
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2005-06-01
Last Update Date:2019-01-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OHNA251E00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes251E00000XAgenciesHome Health
Provider Identifiers
StateIdentifier IDID TypeIssuer
OH0254479Medicaid
OH0254479Medicaid