Healthcare Provider Details

I. General information

NPI: 1003914755
Provider Name (Legal Business Name): DEARTH HOMES, INC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 09/20/2006
Last Update Date: 08/22/2020
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

25326 SNIVELY RD
DANVILLE OH
43014-9761
US

IV. Provider business mailing address

25326 SNIVELY RD
DANVILLE OH
43014-9761
US

V. Phone/Fax

Practice location:
  • Phone: 740-599-6357
  • Fax: 740-599-5692
Mailing address:
  • Phone: 740-599-6357
  • Fax: 740-599-5692

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code332BP3500X
TaxonomyParenteral & Enteral Nutrition Supplies (DME)
License Number0812
License Number StateOH

VIII. Authorized Official

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