Healthcare Provider Details

I. General information

NPI: 1740887751
Provider Name (Legal Business Name): MRS. KELLEY JEAN DUGA
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 10/02/2020
Last Update Date: 10/02/2020
Certification Date: 10/02/2020
Deactivation Date:
Reactivation Date:

III. Provider practice location address

46058 RUSSIA RD
ELYRIA OH
44035
US

IV. Provider business mailing address

46058 RUSSIA RD
ELYRIA OH
44035
US

V. Phone/Fax

Practice location:
  • Phone: 440-371-9772
  • Fax:
Mailing address:
  • Phone: 440-371-9772
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code374U00000X
TaxonomyHome Health Aide
License Number
License Number StateOH
# 2
Primary TaxonomyY
Taxonomy Code376J00000X
TaxonomyHomemaker
License Number
License Number StateOH
# 3
Primary TaxonomyN
Taxonomy Code253Z00000X
TaxonomyIn Home Supportive Care Agency
License Number
License Number StateOH

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: