=====================================================
General NPI Number Information
=====================================================
NPI Number | 1700473014
-----------------------------------------------------
Entity Type | Organization
-----------------------------------------------------
Legal Business Name | RISOR HOME SERVICES LLC
-----------------------------------------------------
=====================================================
Dates
=====================================================
Enumeration Date | 12/22/2020
-----------------------------------------------------
Last Update Date | 12/22/2020
-----------------------------------------------------
=====================================================
Provider Practice Location Address
=====================================================
Address Line | 4011 NEBRASKA AVE
-----------------------------------------------------
City | TOLEDO
-----------------------------------------------------
State | OH
-----------------------------------------------------
Zip | 43607-2235
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 419-283-0677
-----------------------------------------------------
Fax |
-----------------------------------------------------
=====================================================
Provider Business Mailing Address
=====================================================
Address Line | 547 SCENIC CIR
-----------------------------------------------------
City | HOLLAND
-----------------------------------------------------
State | OH
-----------------------------------------------------
Zip | 43528-8698
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 419-283-0677
-----------------------------------------------------
Fax |
-----------------------------------------------------
=====================================================
Authorized Official
=====================================================
Title or Position | CEO
-----------------------------------------------------
Name | MRS. NATWIYA BIRCHFIELD
-----------------------------------------------------
Credential |
-----------------------------------------------------
Telephone | 419-283-0677
-----------------------------------------------------
=====================================================
Scope of Practice (Provider's specialty)
=====================================================
Taxonomy #1
-----------------------------------------------------
Taxonomy Code | 251E00000X
-----------------------------------------------------
Taxonomy Name | Home Health Agency
-----------------------------------------------------
License Number |
-----------------------------------------------------
License Number State |
-----------------------------------------------------