Healthcare Provider Details

I. General information

NPI: 1669681870
Provider Name (Legal Business Name): COMMUNITY AND RURAL HEALTH SERVICES, INC.
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 05/22/2007
Last Update Date: 08/22/2024
Certification Date: 08/22/2024
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2221 HAYES AVE
FREMONT OH
43420-2632
US

IV. Provider business mailing address

2221 HAYES AVE
FREMONT OH
43420-2632
US

V. Phone/Fax

Practice location:
  • Phone: 419-334-8943
  • Fax: 419-334-8619
Mailing address:
  • Phone: 419-334-8943
  • Fax: 419-334-8619

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code261QF0400X
TaxonomyFederally Qualified Health Center (FQHC)
License Number
License Number State
# 2
Primary TaxonomyN
Taxonomy Code261QP2300X
TaxonomyPrimary Care Clinic/Center
License Number
License Number State

VIII. Authorized Official

Name: JOSEPH LISZAK
Title or Position: CEO
Credential:
Phone: 419-334-8943