Provider Demographics
NPI:1881326361
Name:ALPINE HOUSE OF FREMONT, INC.
Entity type:Organization
Organization Name:ALPINE HOUSE OF FREMONT, INC.
Other - Org Name:<UNAVAIL>
Other - Org Type:
Authorized Official - Title/Position:CEO
Authorized Official - Prefix:DR
Authorized Official - First Name:JOSEPH
Authorized Official - Middle Name:K
Authorized Official - Last Name:WELLS
Authorized Official - Suffix:
Authorized Official - Credentials:OTD, OTR/L
Authorized Official - Phone:419-472-5350
Mailing Address - Street 1:1440 S BYRNE RD
Mailing Address - Street 2:
Mailing Address - City:TOLEDO
Mailing Address - State:OH
Mailing Address - Zip Code:43614-2363
Mailing Address - Country:US
Mailing Address - Phone:419-472-5350
Mailing Address - Fax:
Practice Address - Street 1:916 NORTH ST
Practice Address - Street 2:
Practice Address - City:FREMONT
Practice Address - State:OH
Practice Address - Zip Code:43420-1154
Practice Address - Country:US
Practice Address - Phone:419-472-5350
Practice Address - Fax:866-384-6873
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2022-06-24
Last Update Date:2024-08-30
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes310400000XNursing & Custodial Care FacilitiesAssisted Living Facility
Provider Identifiers
StateIdentifier IDID TypeIssuer
OH0002261Medicaid