Healthcare Provider Details

I. General information

NPI: 1407044464
Provider Name (Legal Business Name): THLH, INC.
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 10/04/2007
Last Update Date: 12/12/2007
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

812 PARK AVE E
MANSFIELD OH
44905-2860
US

IV. Provider business mailing address

812 PARK AVE E
MANSFIELD OH
44905-2860
US

V. Phone/Fax

Practice location:
  • Phone: 414-747-9355
  • Fax: 419-589-8892
Mailing address:
  • Phone: 419-747-9355
  • Fax: 419-589-8892

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code111N00000X
TaxonomyChiropractor
License Number2945
License Number StateOH
# 2
Primary TaxonomyN
Taxonomy Code332B00000X
TaxonomyDurable Medical Equipment & Medical Supplies
License Number2945
License Number StateOH

VIII. Authorized Official

Name: DR. TONTOH MONROE SIMPSON
Title or Position: PRESIDENT
Credential: DC
Phone: 419-747-9355