Basic Information
| Provider Information | |||||||||
| NPI: | 1679982870 | ||||||||
| EntityType: | 1 | ||||||||
| ReplacementNPI: | |||||||||
| OrganizationName: | |||||||||
| LastName: | FOX | ||||||||
| FirstName: | ANGELA | ||||||||
| MiddleName: | JEAN | ||||||||
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| Mailing Information | |||||||||
| Address1: | 52 HIGH ST | ||||||||
| Address2: | |||||||||
| City: | SEVILLE | ||||||||
| State: | OH | ||||||||
| PostalCode: | 442739307 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 3304666640 | ||||||||
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| Practice Location | |||||||||
| Address1: | 2803 AKRON RD | ||||||||
| Address2: | |||||||||
| City: | WOOSTER | ||||||||
| State: | OH | ||||||||
| PostalCode: | 44691 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 3302643232 | ||||||||
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| Other Information | |||||||||
| ProviderEnumerationDate: | 08/13/2014 | ||||||||
| LastUpdateDate: | 07/17/2018 | ||||||||
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| ProviderGenderCode: | F | ||||||||
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| IsSoleProprietor: | Y | ||||||||
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Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 171M00000X | N | Other Service Providers | Case Manager/Care Coordinator | 374U00000X | OH | Y | Nursing Service Related Providers | Home Health Aide |
ID Information
| ID | Type | State | Issuer | Description | 2525253 | 05 | OH | MEDICAID |