Healthcare Provider Details

I. General information

NPI: 1639098031
Provider Name (Legal Business Name): GREGORY LEE THOMPSON
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 07/10/2026
Last Update Date: 07/10/2026
Certification Date: 07/11/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2422 GREENLAWN DR
TROY OH
45373-4316
US

IV. Provider business mailing address

2422 GREENLAWN DR
TROY OH
45373-4316
US

V. Phone/Fax

Practice location:
  • Phone: 937-214-0130
  • Fax: 937-440-0001
Mailing address:
  • Phone: 937-214-0130
  • Fax: 937-440-0001

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code253Z00000X
TaxonomyIn Home Supportive Care Agency
License Number
License Number StateOH

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: