Healthcare Provider Details

I. General information

NPI: 1295325124
Provider Name (Legal Business Name): LORENA EVERHART-PROFITT
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 01/25/2021
Last Update Date: 01/25/2021
Certification Date: 01/25/2021
Deactivation Date:
Reactivation Date:

III. Provider practice location address

51615 TOWNSHIP ROAD 224
FRESNO OH
43824-9028
US

IV. Provider business mailing address

PO BOX 376
BALTIC OH
43804-0376
US

V. Phone/Fax

Practice location:
  • Phone: 740-545-0886
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code374U00000X
TaxonomyHome Health Aide
License Number0243786
License Number StateOH

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: