Healthcare Provider Details

I. General information

NPI: 1720222888
Provider Name (Legal Business Name): TRACI LEIGH GREUEY
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 04/20/2009
Last Update Date: 04/20/2009
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2965 N STATE ROUTE 377 NW
MALTA OH
43758-9144
US

IV. Provider business mailing address

2965 N STATE ROUTE 377 NW
MALTA OH
43758-9144
US

V. Phone/Fax

Practice location:
  • Phone: 740-962-5923
  • Fax:
Mailing address:
  • Phone: 740-962-5923
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

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

VIII. Authorized Official

Name: MRS. TRACI LEIGH GREUEY
Title or Position: NON AGENCY PERSONAL CARE AIDE
Credential:
Phone: 740-962-5923