MEDICARE: MISS BERNITA FAYE DIGGS

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	251E00000X	Home Health Agency	0232867	OH

General Provider Information

NPI Number	:	1629676242
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	MISS BERNITA FAYE DIGGS

Provider Business Mailing Address
First Line	:	1787 BRIER ST SE
Second Line	:
City	:	WARREN
State	:	OH
Zip	:	44484-5312
Country	:	US
Telephone Number	:	330-766-9382
Fax Number	:

Provider Business Practice Location Address
First Line	:	1797 BRIER ST SE
Second Line	:
City	:	WARREN
State	:	OH
Zip	:	44484-5312
Country	:	US
Telephone Number	:	234-806-2182
Fax Number	:

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

Provider Enumeration Date	:	10/15/2020
Last Update Date	:	10/15/2020

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