1265857924 NPI number — P & R HOME IV SERVICE, INC.

Table of Contents

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1265857924 NPI number — P & R HOME IV SERVICE, INC.

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
P & R HOME IV SERVICE, 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:
P & R MEDICAL CONNECTION
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:
1265857924
Entity Type Code:
Organization
Replacement NPI:
Last Update Date:
03/04/2014
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
16937 DEFIANCE TRL
Provider Second Line Business Mailing Address:
Provider Business Mailing Address City Name:
VAN WERT
Provider Business Mailing Address State Name:
OH
Provider Business Mailing Address Postal Code:
45891-8619
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
800-587-7670
Provider Business Mailing Address Fax Number:
419-587-2030

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
1018 RALSTON AVENUE
Provider Second Line Business Practice Location Address:
SUITE 107
Provider Business Practice Location Address City Name:
DEFIANCE
Provider Business Practice Location Address State Name:
OH
Provider Business Practice Location Address Postal Code:
43512
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
866-782-2857
Provider Business Practice Location Address Fax Number:
419-782-3765
Provider Enumeration Date:
03/04/2014

Additional Information

Authorized Official

Authorized Official Last Name:
FARRIS
Authorized Official First Name:
ROBIN
Authorized Official Middle Name:
SUE
Authorized Official Title or Position:
SECRETARY/TREASURER
Authorized Official Telephone Number:
800-587-7670

Provider Taxonomy Codes

  • Taxonomy code: 332BX2000X , with the licence number:  HMER22206 , 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)





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