Healthcare Provider Details

I. General information

NPI: 1013811629
Provider Name (Legal Business Name): PATRICIA CAROL VANDERMARK
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 10/06/2026
Last Update Date: 10/06/2026
Certification Date: 10/06/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

5484 GRAND RIDGE DR
GALENA OH
43021-8564
US

IV. Provider business mailing address

5484 GRAND RIDGE DR
GALENA OH
43021-8564
US

V. Phone/Fax

Practice location:
  • Phone: 614-203-5372
  • Fax:
Mailing address:
  • Phone: 614-203-5372
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code385H00000X
TaxonomyRespite Care
License Number
License Number StateOH

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: