Healthcare Provider Details

I. General information

NPI: 1164973509
Provider Name (Legal Business Name): SPENCERS HOME MODIFICATIONS
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 10/20/2016
Last Update Date: 08/22/2025
Certification Date: 08/22/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

334 S WASHINGTON ST
TIFFIN OH
44883-3007
US

IV. Provider business mailing address

334 S WASHINGTON ST
TIFFIN OH
44883-3007
US

V. Phone/Fax

Practice location:
  • Phone: 419-618-1050
  • Fax:
Mailing address:
  • Phone: 419-618-1050
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code171WH0202X
TaxonomyHome Modifications Contractor
License Number
License Number State

VIII. Authorized Official

Name: SCOTT ALLEN SPENCER
Title or Position: OWNER/OPERATOR
Credential:
Phone: 419-618-1050