Healthcare Provider Details

I. General information

NPI: 1841740156
Provider Name (Legal Business Name): BULLOCK HOME CARE
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 10/11/2016
Last Update Date: 10/11/2016
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

128 WEST HIGH STREET
LIMA OH
45801
US

IV. Provider business mailing address

128 W. HIGH STREET
LIMA OH
45801
US

V. Phone/Fax

Practice location:
  • Phone: 419-228-4663
  • Fax: 419-228-0055
Mailing address:
  • Phone: 419-228-4663
  • Fax: 419-228-0055

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code251E00000X
TaxonomyHome Health Agency
License Number
License Number State

VII. Legacy identifiers

For crosswalk purposes, the following legacy (non-NPI) identifiers are available for this provider:

VIII. Authorized Official

Name: MRS. SANDRA JEAN BULLOCK
Title or Position: OWNER/OPERATING MANAGER
Credential: RN, BSN, BSBA
Phone: 419-228-4663