Provider Demographics
NPI:1194806901
Name:VISITING NURSE SERVICE AND AFFILIATES
Entity type:Organization
Organization Name:VISITING NURSE SERVICE AND AFFILIATES
Other - Org Name:<UNAVAIL>
Other - Org Type:
Authorized Official - Title/Position:ADMINISTRATOR
Authorized Official - Prefix:MR
Authorized Official - First Name:JERRY
Authorized Official - Middle Name:
Authorized Official - Last Name:BAUMAN
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:330-861-6165
Mailing Address - Street 1:4080 BRIMFIELD PLAZA
Mailing Address - Street 2:
Mailing Address - City:KENT
Mailing Address - State:OH
Mailing Address - Zip Code:44240-6902
Mailing Address - Country:US
Mailing Address - Phone:330-677-4666
Mailing Address - Fax:330-677-1595
Practice Address - Street 1:4080 BRIMFIELD PLAZA
Practice Address - Street 2:
Practice Address - City:KENT
Practice Address - State:OH
Practice Address - Zip Code:44240-6902
Practice Address - Country:US
Practice Address - Phone:330-677-4666
Practice Address - Fax:330-677-1595
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-10-18
Last Update Date:2020-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OH810120251E00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes251E00000XAgenciesHome Health
Provider Identifiers
StateIdentifier IDID TypeIssuer
OH9072953Medicaid
OH9072953Medicaid