Healthcare Provider Details

I. General information

NPI: 1639067275
Provider Name (Legal Business Name): PATSY N GRAY
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 06/24/2025
Last Update Date: 06/24/2025
Certification Date: 06/24/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

8245 SWIFT RD NW
WAYNESBURG OH
44688-9603
US

IV. Provider business mailing address

8245 SWIFT RD NW
WAYNESBURG OH
44688-9603
US

V. Phone/Fax

Practice location:
  • Phone: 330-371-9211
  • Fax: 330-371-9211
Mailing address:
  • Phone: 330-371-9211
  • Fax: 330-371-9211

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code253Z00000X
TaxonomyIn Home Supportive Care Agency
License Number5361550
License Number StateOH

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: