Basic Information
| Provider Information | |||||||||
| NPI: | 1912971680 | ||||||||
| EntityType: | 2 | ||||||||
| ReplacementNPI: | |||||||||
| OrganizationName: | ABSOLUTE HEALTH SERVICES INC | ||||||||
| LastName: | |||||||||
| FirstName: | |||||||||
| MiddleName: | |||||||||
| NamePrefix: | |||||||||
| NameSuffix: | |||||||||
| Credential: | |||||||||
| OtherOrganizationName: | |||||||||
| OtherOrganizationType: | |||||||||
| OtherLastName: | |||||||||
| OtherFirstName: | |||||||||
| OtherMiddleName: | |||||||||
| OtherNamePrefix: | |||||||||
| OtherNameSuffix: | |||||||||
| OtherCredential: | |||||||||
| OtherLastNameType: | |||||||||
| Mailing Information | |||||||||
| Address1: | PO BOX 519 | ||||||||
| Address2: | |||||||||
| City: | GREEN | ||||||||
| State: | OH | ||||||||
| PostalCode: | 442320519 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 3304988200 | ||||||||
| FaxNumber: | 3304988226 | ||||||||
| Practice Location | |||||||||
| Address1: | 7171 KECK PARK CIR NW STE 100 | ||||||||
| Address2: | |||||||||
| City: | NORTH CANTON | ||||||||
| State: | OH | ||||||||
| PostalCode: | 447206301 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 3304988200 | ||||||||
| FaxNumber: | 3304988226 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 02/17/2006 | ||||||||
| LastUpdateDate: | 04/01/2020 | ||||||||
| NPIDeactivationReasonCode: | |||||||||
| NPIDeactivationDate: | |||||||||
| NPIReactivationDate: | |||||||||
| ProviderGenderCode: | |||||||||
| AuthorizedOfficialLastName: | HULL | ||||||||
| AuthorizedOfficialFirstName: | JODI | ||||||||
| AuthorizedOfficialMiddleName: | L | ||||||||
| AuthorizedOfficialTitleorPosition: | VP, BILLING | ||||||||
| AuthorizedOfficialTelephone: | 3304988047 | ||||||||
| IsSoleProprietor: | |||||||||
| IsOrganizationSubpart: | N | ||||||||
| ParentOrganizationLBN: | |||||||||
| AuthorizedOfficialNamePrefix: | |||||||||
| AuthorizedOfficialNameSuffix: | |||||||||
| AuthorizedOfficialCredential: | |||||||||
| NPICertificationDate: | 04/01/2020 | ||||||||
Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 251E00000X | N | Agencies | Home Health | 335V00000X | Y | Suppliers | Portable X-Ray Supplier |
ID Information
| ID | Type | State | Issuer | Description | 0182529 | 01 | OH | PASSPORT | OTHER | 2127086 | 05 | OH | MEDICAID |