Provider Demographics
NPI:1356375802
Name:DHSC LLC
Entity type:Organization
Organization Name:DHSC LLC
Other - Org Name:<UNAVAIL>
Other - Org Type:
Authorized Official - Title/Position:DIRECTOR OF BUSINESS OFFICE SUPPORT
Authorized Official - Prefix:
Authorized Official - First Name:LAURIE
Authorized Official - Middle Name:
Authorized Official - Last Name:HOLTSFORD
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:615-465-7000
Mailing Address - Street 1:PO BOX 10390
Mailing Address - Street 2:
Mailing Address - City:FORT WAYNE
Mailing Address - State:IN
Mailing Address - Zip Code:46852-0390
Mailing Address - Country:US
Mailing Address - Phone:330-832-8761
Mailing Address - Fax:330-837-6871
Practice Address - Street 1:875 8TH ST NE
Practice Address - Street 2:
Practice Address - City:MASSILLON
Practice Address - State:OH
Practice Address - Zip Code:44646-8503
Practice Address - Country:US
Practice Address - Phone:330-832-8761
Practice Address - Fax:330-837-6871
EIN:<UNAVAIL>
Is Organization Subpart?:Yes
Parent Organization LBN:DHSC LLC
Parent Organization TIN:<UNAVAIL>
Enumeration Date:2006-07-10
Last Update Date:2007-08-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes314000000XNursing & Custodial Care FacilitiesSkilled Nursing Facility
Provider Identifiers
StateIdentifier IDID TypeIssuer
OH5589420Medicaid
365803Medicare Oscar/Certification