MEDICARE: MR. CLIFFORD RAYMOND DEBRILL I CERTIFIED PROVIDER

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	3747A0650X	Attendant Care Provider

General Provider Information

NPI Number	:	1700473048
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	MR. CLIFFORD RAYMOND DEBRILL I CERTIFIED PROVIDER

Provider Business Mailing Address
First Line	:	500 MARLAY RD
Second Line	:
City	:	DAYTON
State	:	OH
Zip	:	45405-1949
Country	:	US
Telephone Number	:	937-723-8209
Fax Number	:	937-979-4298

Provider Business Practice Location Address
First Line	:	500 MARLAY RD
Second Line	:
City	:	DAYTON
State	:	OH
Zip	:	45405-1949
Country	:	US
Telephone Number	:	937-723-8209
Fax Number	:	937-979-4298

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

Provider Enumeration Date	:	12/21/2020
Last Update Date	:	12/21/2020

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