Provider Demographics
NPI:1780777938
Name:VISITING NURSE SERVICE
Entity type:Organization
Organization Name:VISITING NURSE SERVICE
Other - Org Name:<UNAVAIL>
Other - Org Type:
Authorized Official - Title/Position:MANAGER OF PATIENT ACCOUNTS
Authorized Official - Prefix:MRS
Authorized Official - First Name:MICKI
Authorized Official - Middle Name:
Authorized Official - Last Name:MIJAILOVIC
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:330-861-6111
Mailing Address - Street 1:#1 HOME CARE PLACE
Mailing Address - Street 2:
Mailing Address - City:AKRON
Mailing Address - State:OH
Mailing Address - Zip Code:44320
Mailing Address - Country:US
Mailing Address - Phone:330-837-6873
Mailing Address - Fax:330-837-6829
Practice Address - Street 1:100 LINCOLN WAY E
Practice Address - Street 2:SUITE 110
Practice Address - City:MASSILLON
Practice Address - State:OH
Practice Address - Zip Code:44646-6673
Practice Address - Country:US
Practice Address - Phone:330-837-6873
Practice Address - Fax:330-837-6829
EIN:<UNAVAIL>
Is Organization Subpart?:Yes
Parent Organization LBN:VISITING NURSE SERVICE
Parent Organization TIN:<UNAVAIL>
Enumeration Date:2006-10-02
Last Update Date:2011-04-25
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OH810120251E00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes251E00000XAgenciesHome Health
Provider Identifiers
StateIdentifier IDID TypeIssuer
OH9072953Medicaid
OH9072953Medicaid