Healthcare Provider Details

I. General information

NPI: 1720784465
Provider Name (Legal Business Name): HAILEY ANN KELLER
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 02/03/2023
Last Update Date: 02/03/2023
Certification Date: 02/03/2023
Deactivation Date:
Reactivation Date:

III. Provider practice location address

38973 BUTTERNUT RIDGE RD
ELYRIA OH
44035-8306
US

IV. Provider business mailing address

38973 BUTTERNUT RIDGE RD
ELYRIA OH
44035-8306
US

V. Phone/Fax

Practice location:
  • Phone: 440-529-7117
  • Fax:
Mailing address:
  • Phone: 440-529-7117
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code251E00000X
TaxonomyHome Health Agency
License Number
License Number StateOH
# 2
Primary TaxonomyN
Taxonomy Code172A00000X
TaxonomyDriver
License Number
License Number StateOH

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: