Healthcare Provider Details

I. General information

NPI: 1427654557
Provider Name (Legal Business Name): RICKIE BURTON
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 12/04/2020
Last Update Date: 12/04/2020
Certification Date: 12/03/2020
Deactivation Date:
Reactivation Date:

III. Provider practice location address

9 N. RANKIN ST.
SOUTH CHARLESTON OH
45368-4536
US

IV. Provider business mailing address

PO BOX 383
SOUTH CHARLESTON OH
45368-0383
US

V. Phone/Fax

Practice location:
  • Phone: 937-462-7417
  • Fax:
Mailing address:
  • Phone: 937-462-7417
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code253Z00000X
TaxonomyIn Home Supportive Care Agency
License Number
License Number State
# 2
Primary TaxonomyN
Taxonomy Code347C00000X
TaxonomyPrivate Vehicle
License Number
License Number State
# 3
Primary TaxonomyN
Taxonomy Code3747P1801X
TaxonomyPersonal Care Attendant
License Number
License Number State
# 4
Primary TaxonomyY
Taxonomy Code376J00000X
TaxonomyHomemaker
License Number
License Number State

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: