Provider Demographics
NPI:1174054704
Name:HEALTH PROFESSIONALS OF HOLMES COUNTY, INC
Entity type:Organization
Organization Name:HEALTH PROFESSIONALS OF HOLMES COUNTY, INC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:COO
Authorized Official - Prefix:
Authorized Official - First Name:JASON
Authorized Official - Middle Name:
Authorized Official - Last Name:JUSTUS
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:330-674-1584
Mailing Address - Street 1:981 WOOSTER RD
Mailing Address - Street 2:
Mailing Address - City:MILLERSBURG
Mailing Address - State:OH
Mailing Address - Zip Code:44654-1536
Mailing Address - Country:US
Mailing Address - Phone:330-893-1318
Mailing Address - Fax:330-763-2063
Practice Address - Street 1:1261 WOOSTER RD STE 230
Practice Address - Street 2:
Practice Address - City:MILLERSBURG
Practice Address - State:OH
Practice Address - Zip Code:44654-1570
Practice Address - Country:US
Practice Address - Phone:330-893-1318
Practice Address - Fax:330-763-2063
EIN:<UNAVAIL>
Is Organization Subpart?:Yes
Parent Organization LBN:HEALTH PROFESSIONALS OF HOLMES COUNTY
Parent Organization TIN:<UNAVAIL>
Enumeration Date:2017-03-24
Last Update Date:2019-03-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes174400000XOther Service ProvidersSpecialistGroup - Multi-Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
OH2810444Medicaid