Healthcare Provider Details

I. General information

NPI: 1396358941
Provider Name (Legal Business Name): TRULY PEDIATRIC HOME CARE LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 08/24/2020
Last Update Date: 08/24/2020
Certification Date: 08/24/2020
Deactivation Date:
Reactivation Date:

III. Provider practice location address

3639 GREENBAY DR
DAYTON OH
45415-2018
US

IV. Provider business mailing address

3639 GREENBAY DR
DAYTON OH
45415-2018
US

V. Phone/Fax

Practice location:
  • Phone: 937-397-3600
  • Fax: 937-742-7262
Mailing address:
  • Phone: 937-397-3600
  • Fax: 937-742-7262

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code251E00000X
TaxonomyHome Health Agency
License Number
License Number State
# 2
Primary TaxonomyN
Taxonomy Code251J00000X
TaxonomyNursing Care Agency
License Number
License Number State

VIII. Authorized Official

Name: MARCHELLE LYNN HOPSON
Title or Position: OWNER
Credential: RN
Phone: 937-397-3600