Provider Demographics
NPI:1881693125
Name:HOSPICE OF CENTRAL OHIO
Entity type:Organization
Organization Name:HOSPICE OF CENTRAL OHIO
Other - Org Name:<UNAVAIL>
Other - Org Type:
Authorized Official - Title/Position:GENERAL MANAGER, EXECUTIVE VICE PRE
Authorized Official - Prefix:MRS
Authorized Official - First Name:RENEE
Authorized Official - Middle Name:A
Authorized Official - Last Name:SPARKS
Authorized Official - Suffix:
Authorized Official - Credentials:MSN, RN, CHPN
Authorized Official - Phone:740-788-1400
Mailing Address - Street 1:2269 CHERRY VALLEY ROAD
Mailing Address - Street 2:
Mailing Address - City:NEWARK
Mailing Address - State:OH
Mailing Address - Zip Code:43055-9323
Mailing Address - Country:US
Mailing Address - Phone:740-788-1400
Mailing Address - Fax:740-788-1401
Practice Address - Street 1:2269 CHERRY VALLEY ROAD
Practice Address - Street 2:
Practice Address - City:NEWARK
Practice Address - State:OH
Practice Address - Zip Code:43055-9323
Practice Address - Country:US
Practice Address - Phone:740-788-1400
Practice Address - Fax:740-788-1401
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2005-07-19
Last Update Date:2020-04-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OH0012HSP251G00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes251G00000XAgenciesHospice Care, Community Based
Provider Identifiers
StateIdentifier IDID TypeIssuer
OH0820464Medicaid
36-1525Medicare PIN