Waiver Provider

NPI #1255515334 in Ashland, Ohio

Provider Information

NPI Number: 1255515334
Entity Type: Organization
Organization Name: Waiver Provider
Primary Specialty: Home Health
Enumeration Date: Dec 24, 2007
Last Updated: Dec 24, 2007

Practice Location

Address: 1645 HARDING AVE
City: Ashland
State: Ohio
ZIP Code: 44805-3555
Phone: (419) 606-5213

Authorized Official

Name: MRS. CHRISTINA HOPE STANDRIDGE
Title: LPN
Phone: (419) 606-5213

Specialties & Taxonomy Codes

Specialty	Taxonomy Code	Primary
Home Health	251E00000X	Primary

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