Basic Information
| Provider Information | |||||||||
| NPI: | 1780683573 | ||||||||
| EntityType: | 2 | ||||||||
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| OrganizationName: | COMMUNITY AND RURAL HEALTH SERVICES | ||||||||
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| Mailing Information | |||||||||
| Address1: | 2221 HAYES AVE | ||||||||
| Address2: | |||||||||
| City: | FREMONT | ||||||||
| State: | OH | ||||||||
| PostalCode: | 434202632 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 4193348943 | ||||||||
| FaxNumber: | 4193348546 | ||||||||
| Practice Location | |||||||||
| Address1: | 2221 HAYES AVE | ||||||||
| Address2: | |||||||||
| City: | FREMONT | ||||||||
| State: | OH | ||||||||
| PostalCode: | 434202632 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 4193348943 | ||||||||
| FaxNumber: | 4193348546 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 07/14/2005 | ||||||||
| LastUpdateDate: | 07/27/2021 | ||||||||
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| AuthorizedOfficialLastName: | GARZA | ||||||||
| AuthorizedOfficialFirstName: | JESSICA | ||||||||
| AuthorizedOfficialMiddleName: | |||||||||
| AuthorizedOfficialTitleorPosition: | DIRECTOR OF HUMAN RESOURCE | ||||||||
| AuthorizedOfficialTelephone: | 4193348943 | ||||||||
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| IsOrganizationSubpart: | N | ||||||||
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| NPICertificationDate: | 07/27/2021 | ||||||||
Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 261QF0400X | N | Ambulatory Health Care Facilities | Clinic/Center | Federally Qualified Health Center (FQHC) | 261QR1300X | Y | Ambulatory Health Care Facilities | Clinic/Center | Rural Health |
No ID Information.