Healthcare Provider Details

I. General information

NPI: 1033979992
Provider Name (Legal Business Name): TIFFANY RENEE' DILLER
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 03/19/2024
Last Update Date: 01/05/2025
Certification Date: 01/05/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

300 W KIBBY ST
LIMA OH
45804-1252
US

IV. Provider business mailing address

300 W KIBBY ST
LIMA OH
45804-1252
US

V. Phone/Fax

Practice location:
  • Phone: 567-294-1131
  • Fax:
Mailing address:
  • Phone: 567-294-1131
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code251E00000X
TaxonomyHome Health Agency
License Number3650108
License Number StateOH
# 2
Primary TaxonomyN
Taxonomy Code374U00000X
TaxonomyHome Health Aide
License Number
License Number StateNULL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: