Healthcare Provider Details

I. General information

NPI: 1407188469
Provider Name (Legal Business Name): HEALTH PROFESSIONALS OF HOLMES COUNTY, INC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 02/02/2010
Last Update Date: 08/07/2012
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

126 S BROADWAY ST
SUGARCREEK OH
44681-9378
US

IV. Provider business mailing address

1261 WOOSTER RD SUITE 200
MILLERSBURG OH
44654-1568
US

V. Phone/Fax

Practice location:
  • Phone: 330-852-2504
  • Fax: 330-763-2063
Mailing address:
  • Phone: 330-674-3333
  • Fax: 330-763-2063

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code174400000X
TaxonomySpecialist
License Number
License Number State

VIII. Authorized Official

Name: MR. JASON JUSTUS
Title or Position: CHIEF FINANCIAL OFFICER
Credential:
Phone: 330-674-1015