Healthcare Provider Details

I. General information

NPI: 1821840992
Provider Name (Legal Business Name): MR. CALEB RAY VINCENT
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 04/03/2024
Last Update Date: 07/11/2025
Certification Date: 07/02/2025
Deactivation Date: 04/18/2025
Reactivation Date: 05/15/2025

III. Provider practice location address

220 S BREIEL BLVD
MIDDLETOWN OH
45044-5166
US

IV. Provider business mailing address

9 CHESAPEAKE PLZ
CHESAPEAKE OH
45619-1003
US

V. Phone/Fax

Practice location:
  • Phone: 513-849-8670
  • Fax:
Mailing address:
  • Phone: 513-263-0247
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code171M00000X
TaxonomyCase Manager/Care Coordinator
License Number
License Number State

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: