Healthcare Provider Details

I. General information

NPI: 1033974720
Provider Name (Legal Business Name): ANDREW JACKSON JEREMAY JR.
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 02/21/2024
Last Update Date: 02/21/2024
Certification Date: 02/21/2024
Deactivation Date:
Reactivation Date:

III. Provider practice location address

7718 MAIN RD
BERLIN HEIGHTS OH
44814-9500
US

IV. Provider business mailing address

7718 MAIN RD
BERLIN HEIGHTS OH
44814-9500
US

V. Phone/Fax

Practice location:
  • Phone: 419-541-6021
  • Fax:
Mailing address:
  • Phone: 419-541-6021
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code3747P1801X
TaxonomyPersonal Care Attendant
License Number
License Number State

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: