Provider Demographics
NPI:1427645365
Name:BURDINE, RILEY JR
Entity type:Individual
Prefix:
First Name:RILEY
Middle Name:
Last Name:BURDINE
Suffix:JR
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 1:13870 COUNTY ROAD 2230
Mailing Address - Street 2:
Mailing Address - City:WEST UNITY
Mailing Address - State:OH
Mailing Address - Zip Code:43570-9745
Mailing Address - Country:US
Mailing Address - Phone:567-337-9503
Mailing Address - Fax:
Practice Address - Street 1:13870 COUNTY ROAD 2230
Practice Address - Street 2:
Practice Address - City:WEST UNITY
Practice Address - State:OH
Practice Address - Zip Code:43570-9745
Practice Address - Country:US
Practice Address - Phone:567-337-9503
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2020-12-27
Last Update Date:2020-12-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OH8601314251E00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes251E00000XAgenciesHome Health