Healthcare Provider Details

I. General information

NPI: 1235244864
Provider Name (Legal Business Name): DEARTH MANAGEMENT, INC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 08/21/2006
Last Update Date: 08/22/2020
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

4531 COLUMBUS RD
CENTERBURG OH
43011-9401
US

IV. Provider business mailing address

PO BOX 610
CENTERBURG OH
43011-0610
US

V. Phone/Fax

Practice location:
  • Phone: 740-625-5401
  • Fax: 740-625-5367
Mailing address:
  • Phone: 740-625-5401
  • Fax: 740-625-5367

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code314000000X
TaxonomySkilled Nursing Facility
License Number1036
License Number StateOH

VIII. Authorized Official

Name: TAMARA K SHEPHERD
Title or Position: VICE PRESIDENT OF FINANCE
Credential:
Phone: 614-847-1070