Healthcare Provider Details

I. General information

NPI: 1356322390
Provider Name (Legal Business Name): FASSE DABE, LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 11/08/2005
Last Update Date: 05/25/2011
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

7537 EASY ST
MASON OH
45040-9421
US

IV. Provider business mailing address

7537 EASY ST
MASON OH
45040-9421
US

V. Phone/Fax

Practice location:
  • Phone: 513-573-9625
  • Fax: 513-573-9628
Mailing address:
  • Phone: 513-573-9625
  • Fax: 513-573-9828

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code332BP3500X
TaxonomyParenteral & Enteral Nutrition Supplies (DME)
License NumberHMER22180
License Number StateOH

VIII. Authorized Official

Name: MR. KIMBALL LEWIS DABE
Title or Position: MEMBER
Credential: RRT
Phone: 513-573-9625