Provider Demographics
NPI:1427617455
Name:HENDERSON, JOSEPH L SR
Entity type:Individual
Prefix:MR
First Name:JOSEPH
Middle Name:L
Last Name:HENDERSON
Suffix:SR
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 1:836 BROADWAY AVE LOWR LEVEL
Mailing Address - Street 2:
Mailing Address - City:BEDFORD
Mailing Address - State:OH
Mailing Address - Zip Code:44146-3676
Mailing Address - Country:US
Mailing Address - Phone:440-359-2563
Mailing Address - Fax:440-658-7875
Practice Address - Street 1:836 BROADWAY AVE LOWR LEVEL
Practice Address - Street 2:
Practice Address - City:BEDFORD
Practice Address - State:OH
Practice Address - Zip Code:44146-3676
Practice Address - Country:US
Practice Address - Phone:440-359-2563
Practice Address - Fax:440-658-7875
Is Sole Proprietor?:Yes
Enumeration Date:2019-06-12
Last Update Date:2019-06-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes251E00000XAgenciesHome Health
Provider Identifiers
StateIdentifier IDID TypeIssuer
OH000000000OtherI DO NOT HAVE THIS INFORMATION