Provider Demographics
NPI:1003404120
Name:HORODYNSKA, TERESA
Entity type:Individual
Prefix:
First Name:TERESA
Middle Name:
Last Name:HORODYNSKA
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:363 RIDGEMERE WAY
Mailing Address - Street 2:
Mailing Address - City:LANCASTER
Mailing Address - State:OH
Mailing Address - Zip Code:43130-4191
Mailing Address - Country:US
Mailing Address - Phone:740-438-5483
Mailing Address - Fax:
Practice Address - Street 1:363 RIDGEMERE WAY
Practice Address - Street 2:
Practice Address - City:LANCASTER
Practice Address - State:OH
Practice Address - Zip Code:43130-4191
Practice Address - Country:US
Practice Address - Phone:740-438-5483
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2021-01-05
Last Update Date:2021-01-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OH374U00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes374U00000XNursing Service Related ProvidersHome Health AideGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
OH2304625Medicaid