Healthcare Provider Details

I. General information

NPI: 1396598736
Provider Name (Legal Business Name): ELI CHARLES WOODROW
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 04/08/2024
Last Update Date: 04/08/2024
Certification Date: 04/07/2024
Deactivation Date:
Reactivation Date:

III. Provider practice location address

6305 ROCKVILLE RD
BLUE ROCK OH
43720-9561
US

IV. Provider business mailing address

6305 ROCKVILLE RD
BLUE ROCK OH
43720-9561
US

V. Phone/Fax

Practice location:
  • Phone: 740-562-7170
  • Fax:
Mailing address:
  • Phone: 740-562-7170
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code171WH0202X
TaxonomyHome Modifications Contractor
License Number395867
License Number StateOH

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: