Healthcare Provider Details

I. General information

NPI: 1023843109
Provider Name (Legal Business Name): JOSHUA PHILLIPS
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 09/06/2024
Last Update Date: 09/12/2024
Certification Date: 09/12/2024
Deactivation Date:
Reactivation Date:

III. Provider practice location address

4955 SHADY BROOKE RUN
MEDINA OH
44256-8282
US

IV. Provider business mailing address

4955 SHADY BROOKE RUN
MEDINA OH
44256-8282
US

V. Phone/Fax

Practice location:
  • Phone: 440-749-7230
  • Fax:
Mailing address:
  • Phone: 440-749-7230
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code376J00000X
TaxonomyHomemaker
License Number
License Number StateNULL
# 2
Primary TaxonomyN
Taxonomy Code172A00000X
TaxonomyDriver
License Number
License Number StateNULL
# 3
Primary TaxonomyY
Taxonomy Code253Z00000X
TaxonomyIn Home Supportive Care Agency
License Number
License Number StateNULL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: