Healthcare Provider Details

I. General information

NPI: 1114638210
Provider Name (Legal Business Name): WELCOME HOME SIS
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 12/08/2022
Last Update Date: 12/08/2022
Certification Date: 12/08/2022
Deactivation Date:
Reactivation Date:

III. Provider practice location address

58970 VOCATIONAL RD
BYESVILLE OH
43723-9764
US

IV. Provider business mailing address

PO BOX 125
BYESVILLE OH
43723-0125
US

V. Phone/Fax

Practice location:
  • Phone: 740-705-4330
  • Fax:
Mailing address:
  • Phone: 740-705-4330
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code251B00000X
TaxonomyCase Management Agency
License Number
License Number State
# 2
Primary TaxonomyN
Taxonomy Code251S00000X
TaxonomyCommunity/Behavioral Health Agency
License Number
License Number State

VIII. Authorized Official

Name: ANGELA M REGAN
Title or Position: DIRECTOR
Credential:
Phone: 740-705-4330