MEDICARE: MRS. MARY ELLEN VALLANCE

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	253Z00000X	In Home Supportive Care Agency

General Provider Information

NPI Number	:	1548018617
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	MRS. MARY ELLEN VALLANCE

Provider Business Mailing Address
First Line	:	4363 W OAK HARBOR SOUTHEAST RD
Second Line	:
City	:	PORT CLINTON
State	:	OH
Zip	:	43452-8503
Country	:	US
Telephone Number	:	419-656-7423
Fax Number	:

Provider Business Practice Location Address
First Line	:	4363 W OAK HARBOR SOUTHEAST RD
Second Line	:
City	:	PORT CLINTON
State	:	OH
Zip	:	43452-8503
Country	:	US
Telephone Number	:	419-656-7423
Fax Number	:

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

Provider Enumeration Date	:	05/13/2024
Last Update Date	:	05/13/2024

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