Healthcare Provider Details

I. General information

NPI: 1215753967
Provider Name (Legal Business Name): MARIA CRUSET
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 11/26/2024
Last Update Date: 11/26/2024
Certification Date: 11/26/2024
Deactivation Date:
Reactivation Date:

III. Provider practice location address

7339 ONYX WAY
CENTERVILLE OH
45459-3974
US

IV. Provider business mailing address

7339 ONYX WAY
CENTERVILLE OH
45459-3974
US

V. Phone/Fax

Practice location:
  • Phone: 937-673-6858
  • Fax:
Mailing address:
  • Phone: 937-673-6858
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code3747P1801X
TaxonomyPersonal Care Attendant
License Number
License Number StateNULL
# 2
Primary TaxonomyY
Taxonomy Code376J00000X
TaxonomyHomemaker
License Number
License Number StateNULL
# 3
Primary TaxonomyN
Taxonomy Code172A00000X
TaxonomyDriver
License NumberRV320114
License Number StateOH

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: