1952528416 NPI number — MRS. MARCELLA F BROWN PERSONAL NEEDS ASSIS

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 1952528416 NPI number — MRS. MARCELLA F BROWN PERSONAL NEEDS ASSIS

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
Provider Last Name:
BROWN
Provider First Name:
MARCELLA
Provider Middle Name:
F
Provider Name Prefix Text:
MRS.
Provider Name Suffix Text:
Provider Credential Text:
PERSONAL NEEDS ASSIS
Provider Gender Code:
F

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:
1952528416
Entity Type Code:
Individual
Replacement NPI:
Last Update Date:
07/08/2007
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
1714 DOVER AVENUE
Provider Second Line Business Mailing Address:
Provider Business Mailing Address City Name:
PIQUA
Provider Business Mailing Address State Name:
OH
Provider Business Mailing Address Postal Code:
45356-2724
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
937-520-1900
Provider Business Mailing Address Fax Number:
937-973-7914

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
30 EAST BROAD STREET
Provider Second Line Business Practice Location Address:
OHIO DEPT OF JOB & FAMILY SERVICES 33RD FLOOR BUREAU OF
Provider Business Practice Location Address City Name:
COLUMBUS
Provider Business Practice Location Address State Name:
OH
Provider Business Practice Location Address Postal Code:
43215-3414
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
614-466-6742
Provider Business Practice Location Address Fax Number:
614-466-6945
Provider Enumeration Date:
04/19/2007

Additional Information

Authorized Official

Authorized Official Last Name:
Authorized Official First Name:
Authorized Official Middle Name:
Authorized Official Title or Position:
Authorized Official Telephone Number:

Provider Taxonomy Codes

  • Taxonomy code: 374U00000X ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

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

  • Identifier: 2206553 , issued by the state of ( OH ) . This identifiers is of the category "MEDICAID".




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