Provider Demographics
NPI:1285359950
Name:HARGROW, CHARLES JERMAINE
Entity type:Individual
Prefix:
First Name:CHARLES
Middle Name:JERMAINE
Last Name:HARGROW
Suffix:
Gender:M
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:882 DRESSAGE TRCE
Mailing Address - Street 2:
Mailing Address - City:BLACKLICK
Mailing Address - State:OH
Mailing Address - Zip Code:43004-9163
Mailing Address - Country:US
Mailing Address - Phone:614-595-9673
Mailing Address - Fax:
Practice Address - Street 1:882 DRESSAGE TRCE
Practice Address - Street 2:
Practice Address - City:BLACKLICK
Practice Address - State:OH
Practice Address - Zip Code:43004-9163
Practice Address - Country:US
Practice Address - Phone:614-595-9673
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2022-10-05
Last Update Date:2022-10-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OHRR887369253Z00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes253Z00000XAgenciesIn Home Supportive Care