Healthcare Provider Details

I. General information

NPI: 1285776716
Provider Name (Legal Business Name): CHARLENE MCGREW
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 02/12/2007
Last Update Date: 07/09/2007
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2719 NEWLON RD NW
MALTA OH
43758-9761
US

IV. Provider business mailing address

1760 BROADWAY ST
STOCKPORT OH
43787-9113
US

V. Phone/Fax

Practice location:
  • Phone: 740-962-4869
  • Fax:
Mailing address:
  • Phone: 740-559-2717
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code374U00000X
TaxonomyHome Health Aide
License Number
License Number StateOH

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: