Healthcare Provider Details

I. General information

NPI: 1083530422
Provider Name (Legal Business Name): CHRISTOPHER ROSS
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 06/29/2026
Last Update Date: 06/29/2026
Certification Date: 06/29/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

628 HENDRIX BLVD
LAGRANGE OH
44050-9339
US

IV. Provider business mailing address

628 HENDRIX BLVD
LAGRANGE OH
44050-9339
US

V. Phone/Fax

Practice location:
  • Phone: 401-309-1189
  • Fax:
Mailing address:
  • Phone: 401-309-1189
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code172A00000X
TaxonomyDriver
License Number
License Number StateOH
# 2
Primary TaxonomyN
Taxonomy Code376J00000X
TaxonomyHomemaker
License Number
License Number StateOH
# 3
Primary TaxonomyY
Taxonomy Code3747P1801X
TaxonomyPersonal Care Attendant
License Number
License Number StateOH

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: