Healthcare Provider Details

I. General information

NPI: 1386321685
Provider Name (Legal Business Name): BEDROCK AT HOME OHIO LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 06/29/2023
Last Update Date: 06/29/2023
Certification Date: 06/29/2023
Deactivation Date:
Reactivation Date:

III. Provider practice location address

7056 CORPORATE WAY # 201
CENTERVILLE OH
45459-4274
US

IV. Provider business mailing address

7056 CORPORATE WAY # 201
CENTERVILLE OH
45459-4274
US

V. Phone/Fax

Practice location:
  • Phone: 937-306-2251
  • Fax:
Mailing address:
  • Phone: 937-306-2251
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code253Z00000X
TaxonomyIn Home Supportive Care Agency
License Number
License Number State

VIII. Authorized Official

Name: REBECCA GRAJEDA
Title or Position: DIRECTOR OF OPERATIONS
Credential:
Phone: 937-306-2251