Healthcare Provider Details

I. General information

NPI: 1427274802
Provider Name (Legal Business Name): LEOTA M. HUTCHISON
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 04/17/2007
Last Update Date: 08/22/2020
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

7615 BANK ST
APPLE CREEK OH
44606-9668
US

IV. Provider business mailing address

7615 BANK ST
APPLE CREEK OH
44606-9668
US

V. Phone/Fax

Practice location:
  • Phone: 330-698-2031
  • Fax: 330-698-1153
Mailing address:
  • Phone: 330-698-2031
  • Fax: 330-698-1153

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code311ZA0620X
TaxonomyAdult Care Home Facility
License Number8500241
License Number StateOH

VIII. Authorized Official

Name: JUDITH A. HOLMES
Title or Position: BOOKKEEPER
Credential:
Phone: 330-345-2041