Provider Demographics
NPI:1063061489
Name:ACCESS TUSC
Entity type:Organization
Organization Name:ACCESS TUSC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:HUB DIRECTOR
Authorized Official - Prefix:
Authorized Official - First Name:SARAH
Authorized Official - Middle Name:ANN
Authorized Official - Last Name:ENDLICH
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:330-308-3591
Mailing Address - Street 1:PO BOX 314
Mailing Address - Street 2:
Mailing Address - City:DOVER
Mailing Address - State:OH
Mailing Address - Zip Code:44622-0314
Mailing Address - Country:US
Mailing Address - Phone:330-308-3591
Mailing Address - Fax:330-343-4883
Practice Address - Street 1:659 BOULEVARD ST
Practice Address - Street 2:
Practice Address - City:DOVER
Practice Address - State:OH
Practice Address - Zip Code:44622-2026
Practice Address - Country:US
Practice Address - Phone:330-308-3591
Practice Address - Fax:330-343-4883
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2019-09-09
Last Update Date:2019-09-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes172V00000XOther Service ProvidersCommunity Health WorkerGroup - Single Specialty