Healthcare Provider Details

I. General information

NPI: 1871108449
Provider Name (Legal Business Name): DEPENDABLE CARE TRAVELING NP LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 09/10/2020
Last Update Date: 09/12/2020
Certification Date: 09/12/2020
Deactivation Date:
Reactivation Date:

III. Provider practice location address

33 DAYTON AVE
DAYTON OH
45402-6402
US

IV. Provider business mailing address

PO BOX 594
DAYTON OH
45401-0594
US

V. Phone/Fax

Practice location:
  • Phone: 937-974-9398
  • Fax:
Mailing address:
  • Phone: 937-422-8128
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code251E00000X
TaxonomyHome Health Agency
License Number
License Number State
# 2
Primary TaxonomyN
Taxonomy Code251J00000X
TaxonomyNursing Care Agency
License Number
License Number State
# 3
Primary TaxonomyY
Taxonomy Code251K00000X
TaxonomyPublic Health or Welfare Agency
License Number
License Number State

VIII. Authorized Official

Name: MISS POROTHEA LYNNETTE DENNIS
Title or Position: OWNER/PROVIDER
Credential: NP
Phone: 937-974-9398