Provider Demographics
NPI:1093312407
Name:BALENTINE, SUE
Entity Type:Individual
Prefix:
First Name:SUE
Middle Name:
Last Name:BALENTINE
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1699 WOODLAND DR
Mailing Address - Street 2:
Mailing Address - City:COSHOCTON
Mailing Address - State:OH
Mailing Address - Zip Code:43812-3152
Mailing Address - Country:US
Mailing Address - Phone:740-622-1523
Mailing Address - Fax:
Practice Address - Street 1:1699 WOODLAND DR
Practice Address - Street 2:
Practice Address - City:COSHOCTON
Practice Address - State:OH
Practice Address - Zip Code:43812-3152
Practice Address - Country:US
Practice Address - Phone:740-622-1523
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2020-10-08
Last Update Date:2020-10-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes253Z00000XAgenciesIn Home Supportive Care