Healthcare Provider Details

I. General information

NPI: 1457441826
Provider Name (Legal Business Name): WYNN-REETH, INC.
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 10/13/2006
Last Update Date: 08/22/2020
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

137 SOUTH BROADWAY STREET
GREEN SPRINGS OH
44836-0785
US

IV. Provider business mailing address

PO BOX 785
GREEN SPRINGS OH
44836-0785
US

V. Phone/Fax

Practice location:
  • Phone: 419-639-2094
  • Fax: 419-639-2099
Mailing address:
  • Phone: 419-639-2094
  • Fax: 419-639-2099

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code251C00000X
TaxonomyDevelopmentally Disabled Services Day Training Agency
License Number7200184
License Number StateOH

VIII. Authorized Official

Name: MR. JARROD HUNT
Title or Position: CEO
Credential:
Phone: 419-639-2094