NPIMap

Organization Active NPI

Community and Rural Health Services

  • Rural Health Clinic/Center
  • Fremont, OH
National Provider Identifier
1780683573
Registry record updated Jul 27, 2021
On this page

Key facts

NPPES NPI Registry
Primary specialty
Rural Health Clinic/CenterTaxonomy code 261QR1300X
Legal business name
COMMUNITY AND RURAL HEALTH SERVICES
Practice address
2221 Hayes Ave
Fremont, OH 43420-2632
Phone
(419) 334-8943
Fax
(419) 334-8546
NPI assigned
Jul 14, 2005
Last updated
Jul 27, 2021By the provider in NPPES
Organization subpart
No

NPPES NPI Registry

Updated by the provider on Jul 27, 2021

Registry information is reported by the provider to CMS and is not verified. About this source

Authorized official

Name
Jessica Garza
Title
Director of Human Resource
Phone
(419) 334-8943

Specialties & licenses 2

Specialty (taxonomy)CodeLicenseStatePrimary
Federally Qualified Health Center (FQHC) 261QF0400X NU
Rural Health Clinic/Center 261QR1300X NU Primary

Addresses

Primary practice location

2221 Hayes Ave
Fremont, OH 43420-2632

Mailing address

2221 Hayes Ave
Fremont, OH 43420-2632
Phone (419) 334-8943

Medicare participation

Medicare enrollment files
Medicare fee-for-service enrollment
Enrolled in OH4 enrollments

Enrollment records 4

Enrollment IDStateProvider typePAC IDDetails
O20040430001263 OH Part B Supplier - Public Health/Welfare Agency 5395733224 Receives reassigned benefits from 19 practitioners
1 other NPI on this enrollment
Practice locations: Fremont, OH
O20110531000175 OH Part A Provider - Federally Qualified Health Center (FQHC) 5395733224 1 other NPI on this enrollment
Practice locations: Fremont, OH
O20150320000679 OH Part A Provider - Federally Qualified Health Center (FQHC) 5395733224 Practice locations: Fostoria, OH
O20150320001985 OH Part A Provider - Federally Qualified Health Center (FQHC) 5395733224 Practice locations: Stony Ridge, OH

NPI to CCN mapping 3

The Medicare certification numbers (CCNs) connected to NPI 1780683573. Details of each certification follow.

Federally qualified health center certification: CCN 361831

Legal name
COMMUNITY AND RURAL HEALTH SERVICES
Doing business as
COMMUNITY HEALTH SERVICES
Certification status
Active
Provider type (POS)
Federally qualified health center
Participating since
Oct 1, 1991
Last certification
Oct 1, 1991
Ownership / control type
For profit – corporation
Organization structure
CorporationNon-profit
Incorporated
Jun 2, 1970 in OH
Enrollment address
2221 Hayes Ave
Fremont, OH 43420-2632

Federally qualified health center certification: CCN 361069

Legal name
COMMUNITY AND RURAL HEALTH SERVICES
Doing business as
COMMUNITY HEALTH SERVICES-FOSTORIA
Certification status
Active
Provider type (POS)
Federally qualified health center
Participating since
Mar 11, 2015
Last certification
Mar 11, 2015
Ownership / control type
For profit – corporation
Organization structure
CorporationNon-profit
Enrollment address
502 Van Buren St
Fostoria, OH 44830-1533

Federally qualified health center certification: CCN 361070

Legal name
COMMUNITY AND RURAL HEALTH SERVICES
Doing business as
COMMUNITY HEALTH SERVICES-STONY RIDGE
Certification status
Active
Provider type (POS)
Federally qualified health center
Participating since
Mar 11, 2015
Last certification
Mar 11, 2015
Ownership / control type
For profit – corporation
Organization structure
CorporationNon-profit
Enrollment address
5734 Fremont Pike
Stony Ridge, OH 43463

Other NPIs with the same Medicare PAC ID 1

NPIs whose Medicare enrollments share a PECOS associate control ID (the same enrolled entity).

Other NPIs on the same Medicare enrollment 2

NPIs listed together on one Medicare enrollment, typically parts of the same organization.

National Provider Directory

National Provider Directory

Locations

1255 W Main St
Bellevue, OH 44811
Phone (419) 334-3869

502 Van Buren St
Fostoria, OH 44830
Phone (419) 436-6630

1220 E State St
Fremont, OH 43420
Phone (419) 355-8186

2276 W State St
Fremont, OH 43420
Phone (419) 334-9137

1005 Bellefontaine Ave
Ste 300
Lima, OH 45804
Phone (419) 225-0110

3909 Kok Rd
Willard, OH 44890
Phone (419) 933-7408

Ownership & related parties

All disclosed owners & managing parties 12

As disclosed on the Medicare enrollment (CMS All Owners files). Individuals include officers, directors and managing employees, who may not hold ownership.

NameRoleSinceShare
Jose Salinas Individual Corporate DirectorBoard Member Dec 1, 2006
Corporate DirectorBoard Member Jun 8, 2006 100%
Joseph L Liszak Individual Corporate OfficerCeo Jan 1, 1997
Corporate DirectorCeo Jan 1, 1997
W-2 Managing EmployeeCeo Jan 1, 2017
Operational/Managerial ControlCeo Jan 1, 1997 100%
Contracted Managing EmployeeCeo Jan 1, 1997 100%
Corporate OfficerCeo Jan 1, 1997 100%
Courtney Combs Individual Corporate Director May 1, 2016
Delores Burel Individual Corporate Director Dec 1, 2014
James Ellis Individual Corporate DirectorBoard Member Nov 10, 2003
Morgan Stanley Individual Corporate Director Nov 1, 2013
David O'Neal Individual Corporate Director Oct 1, 2015
Irma Celestino Individual Corporate Director Nov 1, 2012
Zesta Johnson Individual Corporate Director Dec 1, 2013
David Pollick Individual Corporate Director Apr 1, 2016
Timothy Buit Individual Corporate DirectorBoard Member Nov 1, 2013
Ann Wise Individual Corporate DirectorBoard Member Jun 1, 2011

Practitioners & affiliated clinicians

Practitioners 26

Individual providers connected to this organization through Medicare benefit reassignment, Care Compare group membership or National Provider Directory roles, and the practitioner matching its NPPES authorized official.

View all 26

NPI Registry JSON

The complete NPPES record for this NPI in the NPI Registry API format.

{
    "created_epoch": "1121299200000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1627344000000",
    "number": "1780683573",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "2221 HAYES AVE",
            "city": "FREMONT",
            "state": "OH",
            "postal_code": "434202632",
            "telephone_number": "419-334-8943",
            "fax_number": "419-334-8546"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "2221 HAYES AVE",
            "city": "FREMONT",
            "state": "OH",
            "postal_code": "434202632",
            "telephone_number": "419-334-8943",
            "fax_number": "419-334-8546"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "COMMUNITY AND RURAL HEALTH SERVICES",
        "organizational_subpart": "NO",
        "enumeration_date": "2005-07-14",
        "last_updated": "2021-07-27",
        "certification_date": "2021-07-27",
        "status": "A",
        "authorized_official_last_name": "GARZA",
        "authorized_official_first_name": "JESSICA",
        "authorized_official_title_or_position": "DIRECTOR OF HUMAN RESOURCE",
        "authorized_official_telephone_number": "419-334-8943"
    },
    "taxonomies": [
        {
            "code": "261QF0400X",
            "taxonomy_group": "",
            "desc": "Clinic/Center, Federally Qualified Health Center (FQHC)",
            "state": "NU",
            "license": null,
            "primary": false
        },
        {
            "code": "261QR1300X",
            "taxonomy_group": "",
            "desc": "Clinic/Center, Rural Health",
            "state": "NU",
            "license": null,
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

Other providers in Fremont, OH

Sources for this page

Verify at the official NPI Registry.