Provider Demographics
NPI:1306081047
Name:DIRECTCARE SUPPORT PROFESSIONALS OF OHIO, LLC
Entity type:Organization
Organization Name:DIRECTCARE SUPPORT PROFESSIONALS OF OHIO, LLC
Other - Org Name:<UNAVAIL>
Other - Org Type:
Authorized Official - Title/Position:CHIEF COMPLIANCE OFFICER
Authorized Official - Prefix:MS
Authorized Official - First Name:CAROL
Authorized Official - Middle Name:ANN
Authorized Official - Last Name:TALLEY
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:614-231-0220
Mailing Address - Street 1:921 ROBINWOOD AVE
Mailing Address - Street 2:SUITE E
Mailing Address - City:WHITEHALL
Mailing Address - State:OH
Mailing Address - Zip Code:43213-6706
Mailing Address - Country:US
Mailing Address - Phone:614-414-0220
Mailing Address - Fax:614-231-0221
Practice Address - Street 1:921 ROBINWOOD AVE
Practice Address - Street 2:SUITE E
Practice Address - City:WHITEHALL
Practice Address - State:OH
Practice Address - Zip Code:43213-6706
Practice Address - Country:US
Practice Address - Phone:614-231-0220
Practice Address - Fax:614-231-0221
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2008-12-10
Last Update Date:2014-02-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes253Z00000XAgenciesIn Home Supportive Care