Healthcare Provider Details

I. General information

NPI: 1114287661
Provider Name (Legal Business Name): SELECTIVE HOME HEALTH SUPPLIES
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 05/17/2012
Last Update Date: 07/21/2022
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2107 JERGENS RD
DAYTON OH
45404-1227
US

IV. Provider business mailing address

2107 JERGENS RD
DAYTON OH
45404-1227
US

V. Phone/Fax

Practice location:
  • Phone: 937-260-4250
  • Fax:
Mailing address:
  • Phone: 937-260-4250
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code332B00000X
TaxonomyDurable Medical Equipment & Medical Supplies
License Number
License Number State

VIII. Authorized Official

Name: RHONDA DEBORD
Title or Position: CO-OWNER
Credential: LPN
Phone: 937-260-4250