Healthcare Provider Details

I. General information

NPI: 1740306463
Provider Name (Legal Business Name): BE SURE NURSING SERVICES
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 03/22/2007
Last Update Date: 08/22/2020
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2807 ATHENS AVE
DAYTON OH
45406-4325
US

IV. Provider business mailing address

2807 ATHENS AVE
DAYTON OH
45406-4325
US

V. Phone/Fax

Practice location:
  • Phone: 937-610-2703
  • Fax:
Mailing address:
  • Phone: 937-610-2703
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code164W00000X
TaxonomyLicensed Practical Nurse
License NumberPN088678
License Number StateOH

VIII. Authorized Official

Name: JEROME ANTHONY DENMARK
Title or Position: DIRECTOR
Credential: LPN
Phone: 937-610-2703