Healthcare Provider Details

I. General information

NPI: 1023032620
Provider Name (Legal Business Name): KAISER FOUNDATION HEALTH PLAN OF OHIO
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 07/27/2006
Last Update Date: 01/05/2011
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

5420 LANCASTER DR
BROOKLYN HEIGHTS OH
44131-1832
US

IV. Provider business mailing address

5420 LANCASTER DR
BROOKLYN HEIGHTS OH
44131-1832
US

V. Phone/Fax

Practice location:
  • Phone: 216-749-8383
  • Fax: 216-778-6040
Mailing address:
  • Phone: 216-749-8383
  • Fax: 216-778-6040

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code251E00000X
TaxonomyHome Health Agency
License Number
License Number State

VIII. Authorized Official

Name: THOMAS R REVIS
Title or Position: VICE PRESIDENT AND CHIEF FINANCIAL
Credential:
Phone: 216-479-5136