Healthcare Provider Details

I. General information

NPI: 1689479628
Provider Name (Legal Business Name): JERRY DARNELL JR.
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 02/14/2025
Last Update Date: 02/14/2025
Certification Date: 02/14/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2224 TORREY HILL DR
TOLEDO OH
43606-4375
US

IV. Provider business mailing address

2224 TORREY HILL DR
TOLEDO OH
43606-4375
US

V. Phone/Fax

Practice location:
  • Phone: 419-508-7433
  • Fax:
Mailing address:
  • Phone: 419-508-7433
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code310400000X
TaxonomyAssisted Living Facility
License NumberRV442166
License Number StateOH
# 2
Primary TaxonomyN
Taxonomy Code343900000X
TaxonomyNon-emergency Medical Transport (VAN)
License NumberRV442166
License Number StateOH
# 3
Primary TaxonomyY
Taxonomy Code172A00000X
TaxonomyDriver
License NumberRV442166
License Number StateOH
# 4
Primary TaxonomyN
Taxonomy Code253Z00000X
TaxonomyIn Home Supportive Care Agency
License NumberRV442166
License Number StateOH

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: