Healthcare Provider Details

I. General information

NPI: 1376465732
Provider Name (Legal Business Name): BRETTA DEE ROUSH
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 07/28/2026
Last Update Date: 07/28/2026
Certification Date: 07/28/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

799 S MAIN ST
LIMA OH
45804-1519
US

IV. Provider business mailing address

799 S MAIN ST
LIMA OH
45804-1519
US

V. Phone/Fax

Practice location:
  • Phone: 567-242-6036
  • Fax: 419-229-2227
Mailing address:
  • Phone: 567-242-6036
  • Fax: 419-229-2227

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: