Organization
PASSPORT HEALTH HOLDINGS, LLC
Active
Other names
Passport Health, PPH Ohio LLC
Organization subpart
No
Provider details
NPI number
Authorized official
JUANA SLACK (MEDICAL BILLING SPECIALIST)
(480) 646-9086
Entity
Organization
Contact information
Practice address
66 S MILLER RD, STE 103, FAIRLAWN, OH 44333
(877) 358-8648
(877) 877-6875
Mailing address
4343 EAST OUTLIER BLVD., SUITE 100W, PHOENIX, AZ 85008-6507
(877) 358-8648
(877) 877-6875
Taxonomy
Speciality
Code
Description
License number
State
172V00000X
Community Health Worker
Primary
—
—
2083P0901X
Public Health & General Preventive Medicine Physician
—
—
261Q00000X
Clinic/Center
—
—
Other
Enumeration date
11/14/2013
Last updated
04/30/2025
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