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General NPI Number Information
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NPI Number | 1790088870
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Entity Type | Organization
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Legal Business Name | WILDHEDGE INC.
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Dates
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Enumeration Date | 12/13/2010
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Last Update Date | 12/13/2010
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Provider Practice Location Address
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Address Line | 9817 N US 42
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City | WAYNESVILLE
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State | OH
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Zip | 45068-9766
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Country | US
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Telephone | 937-886-9013
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Fax | 513-897-0652
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Provider Business Mailing Address
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Address Line | 707 MIAMISBURG CENTERVILLE RD
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City | CENTERVILLE
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State | OH
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Zip | 45459-6522
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Country | US
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Telephone | 937-886-9013
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Fax | 513-897-0652
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Authorized Official
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Title or Position | PRESIDENT
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Name | MR. THOMAS D GASTINEAU
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Credential |
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Telephone | 937-886-9013
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 253Z00000X
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Taxonomy Name | In Home Supportive Care Agency
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License Number |
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License Number State |
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