Healthcare Provider Details

I. General information

NPI: 1578389698
Provider Name (Legal Business Name): MICHAEL JUSTIN HULL
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 11/25/2024
Last Update Date: 11/25/2024
Certification Date: 11/25/2024
Deactivation Date:
Reactivation Date:

III. Provider practice location address

131 BUCKEYE AVE
MANSFIELD OH
44906-2411
US

IV. Provider business mailing address

131 BUCKEYE AVE
MANSFIELD OH
44906-2411
US

V. Phone/Fax

Practice location:
  • Phone: 419-651-3809
  • Fax:
Mailing address:
  • Phone: 419-651-3809
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code3747P1801X
TaxonomyPersonal Care Attendant
License NumberRU581215
License Number StateOH

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: