Healthcare Provider Details

I. General information

NPI: 1205330396
Provider Name (Legal Business Name): ROBERTA L ROGERS
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 03/22/2018
Last Update Date: 10/09/2021
Certification Date: 10/09/2021
Deactivation Date:
Reactivation Date:

III. Provider practice location address

470 MANCHESTER AVE
YOUNGSTOWN OH
44509-1709
US

IV. Provider business mailing address

470 MANCHESTER AVE
YOUNGSTOWN OH
44509-1709
US

V. Phone/Fax

Practice location:
  • Phone: 330-979-1681
  • Fax:
Mailing address:
  • Phone: 330-979-1681
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code374U00000X
TaxonomyHome Health Aide
License Number7801847
License Number StateOH
# 2
Primary TaxonomyY
Taxonomy Code171W00000X
TaxonomyContractor
License Number7801847
License Number StateOH

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: