Healthcare Provider Details

I. General information

NPI: 1457677544
Provider Name (Legal Business Name): RALPH G PERRY
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 04/14/2010
Last Update Date: 04/14/2010
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

5969 E LIVINGSTON AVE SUITE 110
COLUMBUS OH
43232-2907
US

IV. Provider business mailing address

5969 E LIVINGSTON AVE SUITE 110
COLUMBUS OH
43232-2907
US

V. Phone/Fax

Practice location:
  • Phone: 614-863-6950
  • Fax: 614-863-6957
Mailing address:
  • Phone: 614-863-6950
  • Fax: 614-863-6957

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code374U00000X
TaxonomyHome Health Aide
License Number1398813
License Number StateOH
# 2
Primary TaxonomyY
Taxonomy Code163WH0200X
TaxonomyHome Health Registered Nurse
License Number1398813
License Number StateOH
# 3
Primary TaxonomyN
Taxonomy Code164W00000X
TaxonomyLicensed Practical Nurse
License Number1398813
License Number StateOH

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: