MEDICARE: MR. DENNIS G LAVALLEY SR.

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	253Z00000X	In Home Supportive Care Agency

General Provider Information

NPI Number	:	1427773506
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	MR. DENNIS G LAVALLEY SR.

Provider Business Mailing Address
First Line	:	3220 BRIGHAM ST
Second Line	:
City	:	TOLEDO
State	:	OH
Zip	:	43608-2102
Country	:	US
Telephone Number	:	419-787-0296
Fax Number	:

Provider Business Practice Location Address
First Line	:	3220 BRIGHAM ST
Second Line	:
City	:	TOLEDO
State	:	OH
Zip	:	43608-2102
Country	:	US
Telephone Number	:	419-787-0296
Fax Number	:

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	10/11/2022
Last Update Date	:	05/10/2026

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