Healthcare Provider Details

I. General information

NPI: 1629665377
Provider Name (Legal Business Name): RICHARD CAMPBELL
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 12/29/2020
Last Update Date: 12/29/2020
Certification Date: 12/29/2020
Deactivation Date:
Reactivation Date:

III. Provider practice location address

3500 COUNTRY CLUB RD SW
LANCASTER OH
43130-8585
US

IV. Provider business mailing address

PO BOX 236
LANCASTER OH
43130-0236
US

V. Phone/Fax

Practice location:
  • Phone: 404-386-9627
  • Fax:
Mailing address:
  • Phone: 740-438-6962
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code347C00000X
TaxonomyPrivate Vehicle
License Number
License Number State
# 2
Primary TaxonomyY
Taxonomy Code253Z00000X
TaxonomyIn Home Supportive Care Agency
License Number
License Number State

VIII. Authorized Official

Name: MICHELLE COOPERIDER
Title or Position: ADMINISTRATOR
Credential:
Phone: 740-438-6962