Provider Demographics
NPI:1063527562
Name:DEARTH MANAGEMENT, INC
Entity type:Organization
Organization Name:DEARTH MANAGEMENT, INC
Other - Org Name:<UNAVAIL>
Other - Org Type:
Authorized Official - Title/Position:VICE PRESIDENT OF FINANCE
Authorized Official - Prefix:
Authorized Official - First Name:TAMARA
Authorized Official - Middle Name:K
Authorized Official - Last Name:SHEPHERD
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:614-847-1070
Mailing Address - Street 1:134 NORTHWOODS BLVD
Mailing Address - Street 2:
Mailing Address - City:COLUMBUS
Mailing Address - State:OH
Mailing Address - Zip Code:43235-4727
Mailing Address - Country:US
Mailing Address - Phone:614-847-1070
Mailing Address - Fax:614-847-1393
Practice Address - Street 1:134 NORTHWOODS BLVD
Practice Address - Street 2:
Practice Address - City:COLUMBUS
Practice Address - State:OH
Practice Address - Zip Code:43235-4727
Practice Address - Country:US
Practice Address - Phone:614-847-1070
Practice Address - Fax:614-847-1393
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-08-21
Last Update Date:2009-10-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OHM5900207251B00000X
OH411698261QA0600X
OH425015001343900000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes343900000XTransportation ServicesNon-emergency Medical Transport (VAN)
No251B00000XAgenciesCase Management
No261QA0600XAmbulatory Health Care FacilitiesClinic/CenterAdult Day Care
Provider Identifiers
StateIdentifier IDID TypeIssuer
OH0928189Medicaid
OH411698OtherDAY CARE PASSPORT
OH10263129OtherPASSPORT DANVILLE
OH0136641Medicaid
OH10263192OtherPASSPORT BENNINGTON