Provider Demographics
NPI:1417544214
Name:COE, BETH JANINE
Entity type:Individual
Prefix:
First Name:BETH
Middle Name:JANINE
Last Name:COE
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2625 HUSSEY RD
Mailing Address - Street 2:
Mailing Address - City:XENIA
Mailing Address - State:OH
Mailing Address - Zip Code:45385-8773
Mailing Address - Country:US
Mailing Address - Phone:937-572-1545
Mailing Address - Fax:
Practice Address - Street 1:2625 HUSSEY RD
Practice Address - Street 2:
Practice Address - City:XENIA
Practice Address - State:OH
Practice Address - Zip Code:45385-8773
Practice Address - Country:US
Practice Address - Phone:937-572-1545
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2020-12-28
Last Update Date:2020-12-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OH2904245253Z00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes253Z00000XAgenciesIn Home Supportive Care