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General NPI Number Information
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NPI Number | 1245614536
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Entity Type | Organization
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Legal Business Name | PATRIOT HOUSECALL, INC
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Dates
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Enumeration Date | 07/16/2015
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Last Update Date | 08/05/2022
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Provider Practice Location Address
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Address Line | 986 TIBBETTS WICK RD
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City | GIRARD
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State | OH
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Zip | 44420-1120
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Country | US
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Telephone | 330-306-9651
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Fax | 330-395-0133
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Provider Business Mailing Address
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Address Line | 986 TIBBETTS WICK RD
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City | GIRARD
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State | OH
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Zip | 44420-1138
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Country | US
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Telephone | 330-980-9009
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Fax | 330-395-0133
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Authorized Official
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Title or Position | OWNER
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Name | GREGORY DAVIS
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Credential |
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Telephone | 330-306-9651
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 363LP0808X
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Taxonomy Name | Psychiatric/Mental Health Nurse Practitioner
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License Number |
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License Number State |
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Taxonomy #2
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Taxonomy Code | 363LF0000X
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Taxonomy Name | Family Nurse Practitioner
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License Number |
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License Number State |
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