Healthcare Provider Details

I. General information

NPI: 1932362134
Provider Name (Legal Business Name): SUMMIT ACRES HOME CARE
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 07/08/2008
Last Update Date: 07/08/2008
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

39 SUMMIT CT
CALDWELL OH
43724-9033
US

IV. Provider business mailing address

39 SUMMIT CT
CALDWELL OH
43724-9033
US

V. Phone/Fax

Practice location:
  • Phone: 740-732-5712
  • Fax: 740-732-7350
Mailing address:
  • Phone: 740-732-5712
  • Fax: 740-732-7350

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code332BP3500X
TaxonomyParenteral & Enteral Nutrition Supplies (DME)
License Number
License Number StateOH
# 2
Primary TaxonomyN
Taxonomy Code343900000X
TaxonomyNon-emergency Medical Transport (VAN)
License Number
License Number StateOH
# 3
Primary TaxonomyY
Taxonomy Code251E00000X
TaxonomyHome Health Agency
License Number
License Number StateOH

VIII. Authorized Official

Name: DONALD J CROCK
Title or Position: ADMINISTRATOR
Credential:
Phone: 740-732-5712