1447977665 NPI number — SISTER HOME HEALTH CARE PROVIDER LLC

Table of content: KATIE ANNE MANTLE B.S. (NPI 1356875918)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1447977665 NPI number — SISTER HOME HEALTH CARE PROVIDER LLC

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
SISTER HOME HEALTH CARE PROVIDER LLC
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:
Provider Other Organization Name Type Code:
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:
1447977665
Entity Type Code:
Organization
Replacement NPI:
Last Update Date:
10/27/2022
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
4314 SARAH DR
Provider Second Line Business Mailing Address:
Provider Business Mailing Address City Name:
ENGLEWOOD
Provider Business Mailing Address State Name:
OH
Provider Business Mailing Address Postal Code:
45322-2563
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
937-681-8206
Provider Business Mailing Address Fax Number:
937-540-8831

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
4314 SARAH DR
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
ENGLEWOOD
Provider Business Practice Location Address State Name:
OH
Provider Business Practice Location Address Postal Code:
45322-2563
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
937-681-8206
Provider Business Practice Location Address Fax Number:
937-540-8831
Provider Enumeration Date:
10/27/2022

Additional Information

Authorized Official

Authorized Official Last Name:
CRAWL
Authorized Official First Name:
DEBORAH
Authorized Official Middle Name:
ANN
Authorized Official Title or Position:
CEO
Authorized Official Telephone Number:
937-681-8206

Provider Taxonomy Codes

  • Taxonomy code: 251E00000X ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

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





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