Provider Demographics
NPI:1316239783
Name:OHIO EASTERN STAR COMMUNITY SERVICES
Entity type:Organization
Organization Name:OHIO EASTERN STAR COMMUNITY SERVICES
Other - Org Name:<UNAVAIL>
Other - Org Type:
Authorized Official - Title/Position:CEO
Authorized Official - Prefix:MRS
Authorized Official - First Name:LINDA
Authorized Official - Middle Name:
Authorized Official - Last Name:LAMSON
Authorized Official - Suffix:
Authorized Official - Credentials:RN
Authorized Official - Phone:740-397-7509
Mailing Address - Street 1:1451 GAMBIER RD
Mailing Address - Street 2:
Mailing Address - City:MOUNT VERNON
Mailing Address - State:OH
Mailing Address - Zip Code:43050-9112
Mailing Address - Country:US
Mailing Address - Phone:740-397-7509
Mailing Address - Fax:740-397-9752
Practice Address - Street 1:1451 GAMBIER RD
Practice Address - Street 2:
Practice Address - City:MOUNT VERNON
Practice Address - State:OH
Practice Address - Zip Code:43050-9112
Practice Address - Country:US
Practice Address - Phone:740-397-7509
Practice Address - Fax:740-397-9752
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2011-05-04
Last Update Date:2011-05-04
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes251E00000XAgenciesHome Health
Provider Identifiers
StateIdentifier IDID TypeIssuer
OH368296Medicare PIN