Provider Demographics
NPI:1023562279
Name:STAY HOME I WILL, LLC
Entity Type:Organization
Organization Name:STAY HOME I WILL, LLC
Other - Org Name:CONCIERGE CONNECTED CARE
Other - Org Type:Doing Business As
Authorized Official - Title/Position:PRESIDENT/CEO
Authorized Official - Prefix:
Authorized Official - First Name:RADHARAMANAMURTHY
Authorized Official - Middle Name:
Authorized Official - Last Name:GOKULA
Authorized Official - Suffix:
Authorized Official - Credentials:MD,CMD,DIPABLM
Authorized Official - Phone:419-214-1213
Mailing Address - Street 1:11201 SANDUSKY ST STE 101
Mailing Address - Street 2:
Mailing Address - City:PERRYSBURG
Mailing Address - State:OH
Mailing Address - Zip Code:43551-3130
Mailing Address - Country:US
Mailing Address - Phone:419-214-1213
Mailing Address - Fax:419-214-0783
Practice Address - Street 1:11201 SANDUSKY ST STE 101
Practice Address - Street 2:
Practice Address - City:PERRYSBURG
Practice Address - State:OH
Practice Address - Zip Code:43551-3130
Practice Address - Country:US
Practice Address - Phone:419-214-1213
Practice Address - Fax:419-214-0783
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2016-08-04
Last Update Date:2024-01-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OH35-089833207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily MedicineGroup - Single Specialty