Provider Demographics
NPI:1982185740
Name:THE RESPITE CENTERS OF OHIO
Entity Type:Organization
Organization Name:THE RESPITE CENTERS OF OHIO
Other - Org Name:THE RESPITE CENTERS OF OHIO
Other - Org Type:Doing Business As
Authorized Official - Title/Position:DIRECTOR
Authorized Official - Prefix:
Authorized Official - First Name:RACHELLE
Authorized Official - Middle Name:
Authorized Official - Last Name:MACK
Authorized Official - Suffix:
Authorized Official - Credentials:REGISTER NURSE
Authorized Official - Phone:855-707-7770
Mailing Address - Street 1:1814 BAIRSFORD DR
Mailing Address - Street 2:
Mailing Address - City:COLUMBUS
Mailing Address - State:OH
Mailing Address - Zip Code:43232-3007
Mailing Address - Country:US
Mailing Address - Phone:614-572-2803
Mailing Address - Fax:
Practice Address - Street 1:1816 BAIRSFORD DR
Practice Address - Street 2:
Practice Address - City:COLUMBUS
Practice Address - State:OH
Practice Address - Zip Code:43232-3007
Practice Address - Country:US
Practice Address - Phone:855-707-7770
Practice Address - Fax:614-367-6463
EIN:<UNAVAIL>
Is Organization Subpart?:Yes
Parent Organization LBN:PRESTIGIOUS HOME CARE SERVICES
Parent Organization TIN:<UNAVAIL>
Enumeration Date:2018-08-28
Last Update Date:2018-08-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OHRN391386163W00000X
253Z00000X, 385H00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes385H00000XRespite Care FacilityRespite Care
No163W00000XNursing Service ProvidersRegistered NurseGroup - Multi-Specialty
No253Z00000XAgenciesIn Home Supportive Care
Provider Identifiers
StateIdentifier IDID TypeIssuer
001OtherPRIVATE PAY