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General NPI Number Information
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NPI Number | 1922337666
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Entity Type | Organization
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Legal Business Name | BE SURE SERVICES
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Dates
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Enumeration Date | 12/08/2009
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Last Update Date | 12/08/2009
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Provider Practice Location Address
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Address Line | 2807 ATHENS AVE
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City | DAYTON
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State | OH
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Zip | 45406-4325
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Country | US
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Telephone | 937-610-2703
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Fax |
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Provider Business Mailing Address
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Address Line | 2807 ATHENS AVE
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City | DAYTON
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State | OH
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Zip | 45406-4325
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Country | US
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Telephone | 937-610-2703
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Fax |
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Authorized Official
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Title or Position | DIRECTOR
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Name | JEROME A DENMARK
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Credential | PRACTICAL NURSE
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Telephone | 937-610-2703
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 305R00000X
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Taxonomy Name | Preferred Provider Organization
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License Number | PN088678
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License Number State | OH
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