MEDICARE: VETERANS HOME MAINTENANCE LLC

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	302R00000X	Health Maintenance Organization

General Provider Information

NPI Number	:	1174952196
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	VETERANS HOME MAINTENANCE LLC

Provider Business Mailing Address
First Line	:	4939 N ZETZER RD
Second Line	:
City	:	OAK HARBOR
State	:	OH
Zip	:	43449-9744
Country	:	US
Telephone Number	:	419-898-1620
Fax Number	:

Provider Business Practice Location Address
First Line	:	4939 N ZETZER RD
Second Line	:
City	:	OAK HARBOR
State	:	OH
Zip	:	43449-9744
Country	:	US
Telephone Number	:	419-898-1620
Fax Number	:

Authorized Official
Title or Position	:	PRESIDENT
Name	:	DR. GAYLAND JAMES FISHER
Credential	:	PHD, PE
Telephone Number	:	440-227-8051

Provider Enumeration Date	:	11/12/2013
Last Update Date	:	11/12/2013

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