Healthcare Provider Details

I. General information

NPI: 1326765470
Provider Name (Legal Business Name): DYSERV, INC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 10/20/2022
Last Update Date: 10/20/2022
Certification Date: 10/20/2022
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1144 GOODALE BLVD
GRANDVIEW HEIGHTS OH
43212-3728
US

IV. Provider business mailing address

1144 GOODALE BLVD
GRANDVIEW HEIGHTS OH
43212-3728
US

V. Phone/Fax

Practice location:
  • Phone: 614-294-6078
  • Fax: 614-294-6315
Mailing address:
  • Phone: 614-294-6078
  • Fax: 614-294-6315

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code251E00000X
TaxonomyHome Health Agency
License Number
License Number State

VIII. Authorized Official

Name: DAVID SMITH
Title or Position: PRESIDENT
Credential:
Phone: 614-294-6078