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General NPI Number Information
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NPI Number | 1164812707
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Entity Type | Organization
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Legal Business Name | SNOWFLAKE RESIDENTIAL SERVICES
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Dates
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Enumeration Date | 02/04/2015
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Last Update Date | 02/04/2015
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Provider Practice Location Address
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Address Line | 7433 BUNKER RIDGE CT
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City | BLACKLICK
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State | OH
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Zip | 43004-8401
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Country | US
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Telephone | 614-367-9818
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Fax |
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Provider Business Mailing Address
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Address Line | 7433 BUNKER RIDGE CT
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City | BLACKLICK
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State | OH
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Zip | 43004-8401
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Country | US
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Telephone |
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Fax |
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Authorized Official
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Title or Position | CEO
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Name | VICTORIA MADDOX
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Credential |
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Telephone | 614-367-9818
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 251E00000X
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Taxonomy Name | Home Health Agency
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License Number | 2308266
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License Number State | OH
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