Provider Demographics
NPI:1174784979
Name:HEALTHQUEST OF VERMILION
Entity type:Organization
Organization Name:HEALTHQUEST OF VERMILION
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:CEO
Authorized Official - Prefix:MRS
Authorized Official - First Name:CARON
Authorized Official - Middle Name:
Authorized Official - Last Name:KREICHER
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:440-967-4226
Mailing Address - Street 1:4365 LIBERTY AVE
Mailing Address - Street 2:
Mailing Address - City:VERMILION
Mailing Address - State:OH
Mailing Address - Zip Code:44089-2133
Mailing Address - Country:US
Mailing Address - Phone:440-967-4226
Mailing Address - Fax:440-967-0296
Practice Address - Street 1:4365 LIBERTY AVE
Practice Address - Street 2:
Practice Address - City:VERMILION
Practice Address - State:OH
Practice Address - Zip Code:44089-2133
Practice Address - Country:US
Practice Address - Phone:440-967-4226
Practice Address - Fax:440-967-0296
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2008-06-24
Last Update Date:2008-06-24
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical TherapistGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
OH2535895Medicaid