1649717786 NPI number — JARRELL HEALTHCARE LLC

Table of content: (NPI 1649717786)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1649717786 NPI number — JARRELL HEALTHCARE LLC

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
JARRELL HEALTHCARE 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:
1649717786
Entity Type Code:
Organization
Replacement NPI:
Last Update Date:
01/27/2017
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
2621 HIBISCUS WAY
Provider Second Line Business Mailing Address:
#125
Provider Business Mailing Address City Name:
BEAVERCREEK
Provider Business Mailing Address State Name:
OH
Provider Business Mailing Address Postal Code:
45431-2776
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
937-219-5547
Provider Business Mailing Address Fax Number:
937-912-5449

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
2621 HIBISCUS WAY
Provider Second Line Business Practice Location Address:
#125
Provider Business Practice Location Address City Name:
BEAVERCREEK
Provider Business Practice Location Address State Name:
OH
Provider Business Practice Location Address Postal Code:
45431-2776
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
937-219-5547
Provider Business Practice Location Address Fax Number:
937-912-5449
Provider Enumeration Date:
01/27/2017

Additional Information

			
		

Authorized Official

Authorized Official Last Name:
JARRELL
Authorized Official First Name:
KENDRA
Authorized Official Middle Name:
C
Authorized Official Title or Position:
PRESIDENT
Authorized Official Telephone Number:
937-219-5547

Provider Taxonomy Codes

  • Taxonomy code: 363LF0000X , with the licence number:  NP08619 , 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)