Healthcare Provider Details

I. General information

NPI: 1659076339
Provider Name (Legal Business Name): SAVANNAH REDITT
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 04/03/2023
Last Update Date: 04/03/2023
Certification Date: 04/03/2023
Deactivation Date:
Reactivation Date:

III. Provider practice location address

4836 DOUGLAS RD APT 4
TOLEDO OH
43613-3256
US

IV. Provider business mailing address

4836 DOUGLAS RD APT 4
TOLEDO OH
43613-3256
US

V. Phone/Fax

Practice location:
  • Phone: 567-315-5703
  • Fax:
Mailing address:
  • Phone: 567-315-5703
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code374U00000X
TaxonomyHome Health Aide
License Number
License Number StateNULL
# 2
Primary TaxonomyN
Taxonomy Code171W00000X
TaxonomyContractor
License Number
License Number StateNULL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: