Healthcare Provider Details

I. General information

NPI: 1922761915
Provider Name (Legal Business Name): FRONT PORCH CUSTOM BUILDERS, LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 10/18/2021
Last Update Date: 10/18/2021
Certification Date: 10/18/2021
Deactivation Date:
Reactivation Date:

III. Provider practice location address

5667 YORK RD SW
PATASKALA OH
43062-7423
US

IV. Provider business mailing address

5667 YORK RD SW
PATASKALA OH
43062-7423
US

V. Phone/Fax

Practice location:
  • Phone: 614-307-4021
  • Fax:
Mailing address:
  • Phone: 614-307-4021
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code171WH0202X
TaxonomyHome Modifications Contractor
License Number
License Number State
# 2
Primary TaxonomyN
Taxonomy Code251E00000X
TaxonomyHome Health Agency
License Number
License Number State

VIII. Authorized Official

Name: RANDY COLVIN
Title or Position: OWNER/MEMBER
Credential:
Phone: 614-307-4021