Provider Demographics
NPI:1083131429
Name:CHILDS, ANDREA DENISE (HOME CARE PROVIDER)
Entity Type:Individual
Prefix:MRS
First Name:ANDREA
Middle Name:DENISE
Last Name:CHILDS
Suffix:
Gender:F
Credentials:HOME CARE PROVIDER
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:446 FULLER ST
Mailing Address - Street 2:
Mailing Address - City:AKRON
Mailing Address - State:OH
Mailing Address - Zip Code:44306-1866
Mailing Address - Country:US
Mailing Address - Phone:419-318-7094
Mailing Address - Fax:
Practice Address - Street 1:446 FULLER ST
Practice Address - Street 2:
Practice Address - City:AKRON
Practice Address - State:OH
Practice Address - Zip Code:44306-1866
Practice Address - Country:US
Practice Address - Phone:419-318-7094
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2017-08-25
Last Update Date:2022-07-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes374U00000XNursing Service Related ProvidersHome Health Aide