Healthcare Provider Details

I. General information

NPI: 1215022033
Provider Name (Legal Business Name): VISITING NURSE SERVICE AND AFFILIATES
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 10/04/2006
Last Update Date: 08/22/2020
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

225 ELYRIA ST
LODI OH
44254-1031
US

IV. Provider business mailing address

225 ELYRIA ST
LODI OH
44254-1031
US

V. Phone/Fax

Practice location:
  • Phone: 330-948-4053
  • Fax:
Mailing address:
  • Phone: 330-948-4053
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code251E00000X
TaxonomyHome Health Agency
License Number810120
License Number StateOH

VIII. Authorized Official

Name: MR. JERRY BAUMAN
Title or Position: ADMINISTRATOR
Credential:
Phone: 330-861-6165