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General NPI Number Information
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NPI Number | 1679637987
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Entity Type | Organization
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Legal Business Name | DELERISAJBLANK-INC
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Dates
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Enumeration Date | 12/21/2006
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Last Update Date | 08/22/2020
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Provider Practice Location Address
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Address Line | 16507 CLEMENTS RD
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City | MOUNT ORAB
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State | OH
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Zip | 45154-9765
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Country | US
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Telephone | 937-444-3596
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Fax | 937-444-3596
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Provider Business Mailing Address
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Address Line | 16507 CLEMENTS RD
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City | MOUNT ORAB
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State | OH
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Zip | 45154-9765
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Country | US
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Telephone | 937-444-3596
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Fax | 937-444-3596
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Authorized Official
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Title or Position | OWNER
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Name | MRS. DELERISA JANET BLANK
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Credential | HOMECARE PROVIDER
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Telephone | 937-444-3596
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 171WH0202X
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Taxonomy Name | Home Modifications Contractor
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License Number |
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License Number State | OH
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