=====================================================
General NPI Number Information
=====================================================
NPI Number | 1831395193
-----------------------------------------------------
Entity Type | Organization
-----------------------------------------------------
Legal Business Name | OHIO CARE RESPONSE HOME HEALTH AGENCY, CORP
-----------------------------------------------------
=====================================================
Dates
=====================================================
Enumeration Date | 06/25/2007
-----------------------------------------------------
Last Update Date | 07/22/2010
-----------------------------------------------------
=====================================================
Provider Practice Location Address
=====================================================
Address Line | 3437 WHIPPLE AVE NW
-----------------------------------------------------
City | CANTON
-----------------------------------------------------
State | OH
-----------------------------------------------------
Zip | 44718-3034
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 330-491-1650
-----------------------------------------------------
Fax | 330-491-1651
-----------------------------------------------------
=====================================================
Provider Business Mailing Address
=====================================================
Address Line | 3437 WHIPPLE AVE NW
-----------------------------------------------------
City | CANTON
-----------------------------------------------------
State | OH
-----------------------------------------------------
Zip | 44718-3034
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 330-491-1650
-----------------------------------------------------
Fax | 330-491-1651
-----------------------------------------------------
=====================================================
Authorized Official
=====================================================
Title or Position | PRESIDENT
-----------------------------------------------------
Name | MR. FRANCISCO GONZALEZ-ABREU JR.
-----------------------------------------------------
Credential |
-----------------------------------------------------
Telephone | 330-491-1650
-----------------------------------------------------
=====================================================
Scope of Practice (Provider's specialty)
=====================================================
Taxonomy #1
-----------------------------------------------------
Taxonomy Code | 251E00000X
-----------------------------------------------------
Taxonomy Name | Home Health Agency
-----------------------------------------------------
License Number | 1674829
-----------------------------------------------------
License Number State | OH
-----------------------------------------------------