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General NPI Number Information
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NPI Number | 1952594152
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Entity Type | Organization
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Legal Business Name | CUSTOM STAFFING MARYSVILLE INC
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Dates
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Enumeration Date | 08/21/2007
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Last Update Date | 08/21/2007
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Provider Practice Location Address
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Address Line | 232 N MAIN ST SUITE G
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City | MARYSVILLE
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State | OH
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Zip | 43040
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Country | US
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Telephone | 937-644-9675
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Fax | 937-644-9700
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Provider Business Mailing Address
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Address Line | 232 N MAIN ST SUITE G
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City | MARYSVILLE
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State | OH
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Zip | 43040
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Country | US
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Telephone | 937-644-9675
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Fax | 937-644-9700
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Authorized Official
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Title or Position | VICE PRESIDENT
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Name | MR. D ROCHE SIMMONS
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Credential |
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Telephone | 419-221-3838
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 251E00000X
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Taxonomy Name | Home Health Agency
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License Number |
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License Number State |
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