Healthcare Provider Details

I. General information

NPI: 1174876395
Provider Name (Legal Business Name): FAMILY MATTERS 2
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 10/25/2012
Last Update Date: 10/25/2012
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

3226 DOLORES AVE
TOLEDO OH
43607-2724
US

IV. Provider business mailing address

3226 DOLORES AVE
TOLEDO OH
43607-2724
US

V. Phone/Fax

Practice location:
  • Phone: 419-779-4694
  • Fax:
Mailing address:
  • Phone: 419-779-4694
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code374U00000X
TaxonomyHome Health Aide
License Number
License Number StateOH
# 2
Primary TaxonomyY
Taxonomy Code376K00000X
TaxonomyNurse's Aide
License Number377746511098
License Number StateOH

VIII. Authorized Official

Name: MRS. NACHAEL MARIE CHURCH
Title or Position: STNA
Credential:
Phone: 419-779-4694