1235244864 NPI number — DEARTH MANAGEMENT, INC

Table of content: (NPI 1235244864)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1235244864 NPI number — DEARTH MANAGEMENT, INC

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
DEARTH MANAGEMENT, INC
Provider Last Name:
Provider First Name:
Provider Middle Name:
Provider Name Prefix Text:
Provider Name Suffix Text:
Provider Credential Text:
Provider Gender Code:

Provider's Other Name Information

Provider Other Organization Name:
MORNING VIEW CARE CENTER OF CENTERBURG
Provider Other Organization Name Type Code:
3
Provider Other Last Name:
Provider Other First Name:
Provider Other Middle Name:
Provider Other Name Prefix Text:
Provider Other Name Suffix Text:
Provider Other Credential Text:
Provider Other Last Name Type Code:

NPI Number Information

NPI Number:
1235244864
Entity Type Code:
Organization
Replacement NPI:
Last Update Date:
08/22/2020
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
PO BOX 610
Provider Second Line Business Mailing Address:
Provider Business Mailing Address City Name:
CENTERBURG
Provider Business Mailing Address State Name:
OH
Provider Business Mailing Address Postal Code:
43011-0610
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
740-625-5401
Provider Business Mailing Address Fax Number:
740-625-5367

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
4531 COLUMBUS RD
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
CENTERBURG
Provider Business Practice Location Address State Name:
OH
Provider Business Practice Location Address Postal Code:
43011-9401
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
740-625-5401
Provider Business Practice Location Address Fax Number:
740-625-5367
Provider Enumeration Date:
08/21/2006

Additional Information

Authorized Official

Authorized Official Last Name:
SHEPHERD
Authorized Official First Name:
TAMARA
Authorized Official Middle Name:
K
Authorized Official Title or Position:
VICE PRESIDENT OF FINANCE
Authorized Official Telephone Number:
614-847-1070

Provider Taxonomy Codes

  • Taxonomy code: 314000000X , with the licence number:  1036 , registered in the state of OH ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

Other Provider's Identifiers (legacy, non-NPI)

  • Identifier: 0398574 , issued by the state of ( OH ) . This identifiers is of the category "MEDICAID".




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