MEDICARE: DS MALE GROUP HOME FAMILY HOME

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	251E00000X	Home Health Agency		OH

General Provider Information

NPI Number	:	1134390107
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	DS MALE GROUP HOME FAMILY HOME

Provider Business Mailing Address
First Line	:	1214 PECK STREET
Second Line	:
City	:	TOLEDO
State	:	OH
Zip	:	43608
Country	:	US
Telephone Number	:	419-932-4959
Fax Number	:

Provider Business Practice Location Address
First Line	:	1214 PECK STREET
Second Line	:
City	:	TOLEDO
State	:	OH
Zip	:	43608
Country	:	US
Telephone Number	:	419-243-8534
Fax Number	:

Authorized Official
Title or Position	:	OWNER
Name	:	MS. YOLANDA DEANNE DABNEY
Credential	:	RN
Telephone Number	:	419-932-4959

Provider Enumeration Date	:	03/18/2008
Last Update Date	:	03/21/2008

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