Provider Demographics
NPI:1265532246
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?:Yes
Parent Organization LBN:HOSPICE OF CENTRAL OHIO
Parent Organization TIN:<UNAVAIL>
Enumeration Date:2006-09-22
Last Update Date:2021-12-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OH0012HSP207QH0002X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207QH0002XAllopathic & Osteopathic PhysiciansFamily MedicineHospice and Palliative MedicineGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
OH2923117Medicaid