MEDICARE: ROCHELLE BALK

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	251J00000X	Nursing Care Agency	PN107826	OH

General Provider Information

NPI Number	:	1033428370
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	ROCHELLE BALK

Provider Business Mailing Address
First Line	:	4974 SCOTT ST
Second Line	:
City	:	NEWTON FALLS
State	:	OH
Zip	:	44444-9405
Country	:	US
Telephone Number	:	330-219-4478
Fax Number	:

Provider Business Practice Location Address
First Line	:	4974 SCOTT ST
Second Line	:
City	:	NEWTON FALLS
State	:	OH
Zip	:	44444-9405
Country	:	US
Telephone Number	:	330-219-4478
Fax Number	:

Authorized Official
Title or Position	:	LICENSED PRACTICAL NURSE
Name	:	ROCHELLE LYNN BALK
Credential	:
Telephone Number	:	330-219-4478

Provider Enumeration Date	:	10/05/2010
Last Update Date	:	10/05/2010

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