NPIMap

Organization Active NPI

Passport Health Holdings, LLC

  • Community Health Worker
  • Fairlawn, OH
National Provider Identifier
1972933786
Registry record updated Apr 30, 2025
On this page

Key facts

NPPES NPI Registry
Primary specialty
Community Health WorkerTaxonomy code 172V00000X
Legal business name
PASSPORT HEALTH HOLDINGS, LLC
Practice address
66 S Miller Rd
Ste 103
Fairlawn, OH 44333
Phone
(877) 358-8648
Fax
(877) 877-6875
NPI assigned
Nov 14, 2013
Organization subpart
No

NPPES NPI Registry

Updated by the provider on Apr 30, 2025

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

Authorized official

Name
Juana Slack
Title
Medical Billing Specialist
Phone
(480) 646-9086

Specialties & licenses 3

Specialty (taxonomy)CodeLicenseStatePrimary
Community Health WorkerGroup: 193200000X MULTI-SPECIALTY GROUP 172V00000X Primary
Public Health & General Preventive Medicine PhysicianGroup: 193200000X MULTI-SPECIALTY GROUP 2083P0901X
Clinic/Center 261Q00000X

Addresses

Primary practice location

66 S Miller Rd
Ste 103
Fairlawn, OH 44333

Mailing address

4343 East Outlier Blvd.
Suite 100W
Phoenix, AZ 85008-6507
Phone (877) 358-8648

Other names 2

  • Passport Health Doing business as
  • PPH Ohio LLC Former legal business name

National Provider Directory

National Provider Directory
Tax ID family
Passport Health Holdings LLC218 organizations share this tax ID, including this one

Organizations with this tax ID in the same state 11

This tax ID family is large, so up to 24 of its organizations in the same state are linked here.

Locations

3610 W Market St
Ste 104
Fairlawn, OH 44333

66 S Miller Rd
Ste 103
Fairlawn, OH 44333
Phone (330) 379-0363

NPI Registry JSON

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

{
    "created_epoch": "1384387200000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1745971200000",
    "number": "1972933786",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "4343 EAST OUTLIER BLVD.",
            "address_2": "SUITE 100W",
            "city": "PHOENIX",
            "state": "AZ",
            "postal_code": "850086507",
            "telephone_number": "877-358-8648",
            "fax_number": "877-877-6875"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "66 S MILLER RD",
            "address_2": "STE 103",
            "city": "FAIRLAWN",
            "state": "OH",
            "postal_code": "44333",
            "telephone_number": "877-358-8648",
            "fax_number": "877-877-6875"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "PASSPORT HEALTH HOLDINGS, LLC",
        "organizational_subpart": "NO",
        "enumeration_date": "2013-11-14",
        "last_updated": "2025-04-30",
        "certification_date": "2022-04-01",
        "status": "A",
        "authorized_official_last_name": "SLACK",
        "authorized_official_first_name": "JUANA",
        "authorized_official_title_or_position": "MEDICAL BILLING SPECIALIST",
        "authorized_official_telephone_number": "480-646-9086"
    },
    "taxonomies": [
        {
            "code": "172V00000X",
            "taxonomy_group": "193200000X MULTI-SPECIALTY GROUP",
            "desc": "Community Health Worker",
            "state": null,
            "license": null,
            "primary": true
        },
        {
            "code": "2083P0901X",
            "taxonomy_group": "193200000X MULTI-SPECIALTY GROUP",
            "desc": "Preventive Medicine, Public Health & General Preventive Medicine",
            "state": null,
            "license": null,
            "primary": false
        },
        {
            "code": "261Q00000X",
            "taxonomy_group": "",
            "desc": "Clinic/Center",
            "state": null,
            "license": null,
            "primary": false
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": [
        {
            "organization_name": "Passport Health",
            "code": "3",
            "type": "Doing Business As"
        },
        {
            "organization_name": "PPH Ohio LLC",
            "code": "4",
            "type": "Former Legal Business Name"
        },
        {
            "organization_name": "PPH Ohio LLC",
            "code": "4",
            "type": "Former Legal Business Name"
        }
    ]
}

Other providers in Fairlawn, OH

Sources for this page

  • NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Apr 30, 2025; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
  • National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.