Provider Demographics
NPI:1104838523
Name:EIERMANN, THERESA CHRISTINA (CERTIFIED HPC/HCBS)
Entity type:Individual
Prefix:
First Name:THERESA
Middle Name:CHRISTINA
Last Name:EIERMANN
Suffix:
Gender:F
Credentials:CERTIFIED HPC/HCBS
Other - Prefix:
Other - First Name:TERI
Other - Middle Name:
Other - Last Name:EIERMANN
Other - Suffix:
Other - Last Name Type:Other Name
Other - Credentials:
Mailing Address - Street 1:8232 PARK AVE
Mailing Address - Street 2:
Mailing Address - City:GARRETTSVILLE
Mailing Address - State:OH
Mailing Address - Zip Code:44231-1224
Mailing Address - Country:US
Mailing Address - Phone:330-527-5519
Mailing Address - Fax:330-527-5519
Practice Address - Street 1:8232 PARK AVE
Practice Address - Street 2:
Practice Address - City:GARRETTSVILLE
Practice Address - State:OH
Practice Address - Zip Code:44231-1224
Practice Address - Country:US
Practice Address - Phone:330-527-5519
Practice Address - Fax:330-527-5519
Is Sole Proprietor?:Yes
Enumeration Date:2006-08-13
Last Update Date:2016-04-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OH172A00000X
372600000X, 376J00000X, 177F00000X, 385H00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes376J00000XNursing Service Related ProvidersHomemaker
No172A00000XOther Service ProvidersDriver
No372600000XNursing Service Related ProvidersAdult Companion
No177F00000XOther Service ProvidersLodging
No385H00000XRespite Care FacilityRespite Care
Provider Identifiers
StateIdentifier IDID TypeIssuer
OH2242906Medicaid
OH6700985Medicaid