Healthcare Provider Details

I. General information

NPI: 1699180687
Provider Name (Legal Business Name): LESLEE ELDRIDGE
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 06/27/2014
Last Update Date: 11/17/2020
Certification Date: 11/17/2020
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2458 TOWNSEND RD
MARTINSVILLE OH
45146
US

IV. Provider business mailing address

2458 TOWNSEND RD
MARTINSVILLE OH
45146
US

V. Phone/Fax

Practice location:
  • Phone: 937-728-1912
  • Fax: 937-728-1912
Mailing address:
  • Phone: 937-728-1912
  • Fax: 937-728-1912

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code3747P1801X
TaxonomyPersonal Care Attendant
License Number
License Number StateNULL
# 2
Primary TaxonomyN
Taxonomy Code376J00000X
TaxonomyHomemaker
License Number
License Number StateNULL
# 3
Primary TaxonomyN
Taxonomy Code172A00000X
TaxonomyDriver
License Number
License Number StateNULL
# 4
Primary TaxonomyY
Taxonomy Code171M00000X
TaxonomyCase Manager/Care Coordinator
License Number
License Number StateNULL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: