Provider Demographics
NPI:1831185255
Name:ACCESS TO INDEPENDENCE
Entity type:Organization
Organization Name:ACCESS TO INDEPENDENCE
Other - Org Name:<UNAVAIL>
Other - Org Type:
Authorized Official - Title/Position:CEO
Authorized Official - Prefix:
Authorized Official - First Name:LYN
Authorized Official - Middle Name:S
Authorized Official - Last Name:WEISS
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:330-296-8111
Mailing Address - Street 1:4960 S PROSPECT ST
Mailing Address - Street 2:
Mailing Address - City:RAVENNA
Mailing Address - State:OH
Mailing Address - Zip Code:44266-9016
Mailing Address - Country:US
Mailing Address - Phone:330-296-8111
Mailing Address - Fax:330-296-0539
Practice Address - Street 1:4960 S PROSPECT ST
Practice Address - Street 2:
Practice Address - City:RAVENNA
Practice Address - State:OH
Practice Address - Zip Code:44266-9016
Practice Address - Country:US
Practice Address - Phone:330-296-8111
Practice Address - Fax:330-296-0539
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2005-09-21
Last Update Date:2025-04-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OH332B00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes332B00000XSuppliersDurable Medical Equipment & Medical Supplies
Provider Identifiers
StateIdentifier IDID TypeIssuer
OH0173904Medicaid
OH0173904Medicaid