Healthcare Provider Details

I. General information

NPI: 1235726746
Provider Name (Legal Business Name): RESIDENTIAL INC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 12/30/2020
Last Update Date: 12/30/2020
Certification Date: 12/30/2020
Deactivation Date:
Reactivation Date:

III. Provider practice location address

226 S MAIN ST
NEW LEXINGTON OH
43764-1369
US

IV. Provider business mailing address

PO BOX 101
NEW LEXINGTON OH
43764-0101
US

V. Phone/Fax

Practice location:
  • Phone: 740-342-4158
  • Fax: 740-342-4218
Mailing address:
  • Phone: 740-342-4158
  • Fax: 740-342-4218

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code253Z00000X
TaxonomyIn Home Supportive Care Agency
License Number
License Number State
# 2
Primary TaxonomyN
Taxonomy Code261QA0600X
TaxonomyAdult Day Care Clinic/Center
License Number
License Number State

VIII. Authorized Official

Name: GRETCHEN BROWN
Title or Position: FISCAL MANAGER
Credential:
Phone: 740-642-4158