Basic Information
| Provider Information | |||||||||
| NPI: | 1669681870 | ||||||||
| EntityType: | 2 | ||||||||
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| OrganizationName: | COMMUNITY AND RURAL HEALTH SERVICES, INC. | ||||||||
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| Mailing Information | |||||||||
| Address1: | 2221 HAYES AVE | ||||||||
| Address2: | |||||||||
| City: | FREMONT | ||||||||
| State: | OH | ||||||||
| PostalCode: | 434202632 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 4193348943 | ||||||||
| FaxNumber: | 4193348619 | ||||||||
| Practice Location | |||||||||
| Address1: | 2221 HAYES AVE | ||||||||
| Address2: | |||||||||
| City: | FREMONT | ||||||||
| State: | OH | ||||||||
| PostalCode: | 434202632 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 4193348943 | ||||||||
| FaxNumber: | 4193348619 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 05/22/2007 | ||||||||
| LastUpdateDate: | 12/18/2018 | ||||||||
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| AuthorizedOfficialLastName: | ROOT | ||||||||
| AuthorizedOfficialFirstName: | MANDY | ||||||||
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| AuthorizedOfficialTitleorPosition: | PATIENT ACCOUNT MANAGER | ||||||||
| AuthorizedOfficialTelephone: | 4193348943 | ||||||||
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| IsOrganizationSubpart: | N | ||||||||
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Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 261QP2300X | Y | Ambulatory Health Care Facilities | Clinic/Center | Primary Care |
ID Information
| ID | Type | State | Issuer | Description | 0826388 | 05 | OH | MEDICAID | 0415465 | 05 | OH | MEDICAID |