Healthcare Provider Details

I. General information

NPI: 1174455174
Provider Name (Legal Business Name): CALEB WALLER QBHS-HS
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 06/02/2026
Last Update Date: 06/02/2026
Certification Date: 06/02/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

4764 FISHBURG RD STE E
HUBER HEIGHTS OH
45424-5456
US

IV. Provider business mailing address

4764 FISHBURG RD STE E
HUBER HEIGHTS OH
45424-5456
US

V. Phone/Fax

Practice location:
  • Phone: 317-531-7990
  • Fax: 937-660-4071
Mailing address:
  • Phone: 317-531-7990
  • Fax: 937-660-4071

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code171M00000X
TaxonomyCase Manager/Care Coordinator
License Number
License Number State

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: