Provider Demographics
NPI:1962233080
Name:ANDRICK, JUSTIN WESLEY SR
Entity type:Individual
Prefix:
First Name:JUSTIN
Middle Name:WESLEY
Last Name:ANDRICK
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 1:500 GIRARD AVE
Mailing Address - Street 2:
Mailing Address - City:MARION
Mailing Address - State:OH
Mailing Address - Zip Code:43302-4918
Mailing Address - Country:US
Mailing Address - Phone:740-914-0373
Mailing Address - Fax:
Practice Address - Street 1:500 GIRARD AVE
Practice Address - Street 2:
Practice Address - City:MARION
Practice Address - State:OH
Practice Address - Zip Code:43302-4918
Practice Address - Country:US
Practice Address - Phone:740-914-0373
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2024-08-10
Last Update Date:2024-08-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes253Z00000XAgenciesIn Home Supportive Care
No251E00000XAgenciesHome Health