Healthcare Provider Details

I. General information

NPI: 1689390882
Provider Name (Legal Business Name): 4A HOUSING LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 10/18/2022
Last Update Date: 10/18/2022
Certification Date: 10/18/2022
Deactivation Date:
Reactivation Date:

III. Provider practice location address

V538 COUNTY ROAD 4A
LIBERTY CENTER OH
43532-8512
US

IV. Provider business mailing address

V538 COUNTY ROAD 4A
LIBERTY CENTER OH
43532-8512
US

V. Phone/Fax

Practice location:
  • Phone: 419-966-6384
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code347E00000X
TaxonomyTransportation Broker
License Number
License Number State
# 2
Primary TaxonomyN
Taxonomy Code376J00000X
TaxonomyHomemaker
License Number
License Number State

VIII. Authorized Official

Name: BRADLEY BOOTH
Title or Position: DOO
Credential:
Phone: 419-966-6384