Healthcare Provider Details

I. General information

NPI: 1063527562
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: 10/13/2009
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

134 NORTHWOODS BLVD
COLUMBUS OH
43235-4727
US

IV. Provider business mailing address

134 NORTHWOODS BLVD
COLUMBUS OH
43235-4727
US

V. Phone/Fax

Practice location:
  • Phone: 614-847-1070
  • Fax: 614-847-1393
Mailing address:
  • Phone: 614-847-1070
  • Fax: 614-847-1393

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code251B00000X
TaxonomyCase Management Agency
License NumberM5900207
License Number StateOH
# 2
Primary TaxonomyN
Taxonomy Code261QA0600X
TaxonomyAdult Day Care Clinic/Center
License Number411698
License Number StateOH
# 3
Primary TaxonomyY
Taxonomy Code343900000X
TaxonomyNon-emergency Medical Transport (VAN)
License Number425015001
License Number StateOH

VIII. Authorized Official

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