Provider Demographics
NPI:1962054361
Name:KELCH, JACOBO
Entity type:Individual
Prefix:
First Name:JACOBO
Middle Name:
Last Name:KELCH
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 1:204 WOODWARD ST
Mailing Address - Street 2:
Mailing Address - City:MOUNT ORAB
Mailing Address - State:OH
Mailing Address - Zip Code:45154-9461
Mailing Address - Country:US
Mailing Address - Phone:513-926-6055
Mailing Address - Fax:
Practice Address - Street 1:9915 DAY HILL ARNHEIM RD
Practice Address - Street 2:
Practice Address - City:GEORGETOWN
Practice Address - State:OH
Practice Address - Zip Code:45121-8234
Practice Address - Country:US
Practice Address - Phone:513-926-6055
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2019-07-15
Last Update Date:2019-07-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OH374U00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes374U00000XNursing Service Related ProvidersHome Health Aide