MEDICARE: DEARTH MANAGEMENT, INC

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	314000000X	Skilled Nursing Facility	1036	OH

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program

General Provider Information

NPI Number	:	1235244864
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	DEARTH MANAGEMENT, INC

Provider Business Mailing Address
First Line	:	PO BOX 610
Second Line	:
City	:	CENTERBURG
State	:	OH
Zip	:	43011-0610
Country	:	US
Telephone Number	:	740-625-5401
Fax Number	:	740-625-5367

Provider Business Practice Location Address
First Line	:	4531 COLUMBUS RD
Second Line	:
City	:	CENTERBURG
State	:	OH
Zip	:	43011-9401
Country	:	US
Telephone Number	:	740-625-5401
Fax Number	:	740-625-5367

Authorized Official
Title or Position	:	VICE PRESIDENT OF FINANCE
Name	:	TAMARA K SHEPHERD
Credential	:
Telephone Number	:	614-847-1070

Provider Enumeration Date	:	08/21/2006
Last Update Date	:	08/22/2020

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Directions to “DEARTH MANAGEMENT, INC ” Practice Location

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