MEDICARE: JEFFERY COFFEY SR.

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	374U00000X	Home Health Aide

General Provider Information

NPI Number	:	1205687001
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	JEFFERY COFFEY SR.

Provider Business Mailing Address
First Line	:	1228 ARDMORE AVE SW
Second Line	:
City	:	CANTON
State	:	OH
Zip	:	44710-2147
Country	:	US
Telephone Number	:	234-706-9158
Fax Number	:

Provider Business Practice Location Address
First Line	:	1228 ARDMORE AVE SW
Second Line	:
City	:	CANTON
State	:	OH
Zip	:	44710-2147
Country	:	US
Telephone Number	:	234-706-9158
Fax Number	:

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	03/29/2024
Last Update Date	:	03/29/2024

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Directions to “ JEFFERY COFFEY SR. ” Practice Location

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