Provider Demographics
NPI:1205069978
Name:INCARE HOSPICE, NORTHERN OHIO
Entity type:Organization
Organization Name:INCARE HOSPICE, NORTHERN OHIO
Other - Org Name:<UNAVAIL>
Other - Org Type:
Authorized Official - Title/Position:CEO
Authorized Official - Prefix:
Authorized Official - First Name:ED
Authorized Official - Middle Name:
Authorized Official - Last Name:NEWTON
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:330-335-9999
Mailing Address - Street 1:600 E SMITH RD
Mailing Address - Street 2:
Mailing Address - City:MEDINA
Mailing Address - State:OH
Mailing Address - Zip Code:44256-2666
Mailing Address - Country:US
Mailing Address - Phone:330-335-9999
Mailing Address - Fax:330-335-2360
Practice Address - Street 1:600 E SMITH RD
Practice Address - Street 2:
Practice Address - City:MEDINA
Practice Address - State:OH
Practice Address - Zip Code:44256-2666
Practice Address - Country:US
Practice Address - Phone:330-335-9999
Practice Address - Fax:330-335-2360
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2009-08-28
Last Update Date:2022-05-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes251G00000XAgenciesHospice Care, Community Based
Provider Identifiers
StateIdentifier IDID TypeIssuer
OH0061788Medicaid
361657Medicare PIN