Provider Demographics
NPI:1114151891
Name:SHELBY HOME & PUBLIC HEALTH, INC.
Entity Type:Organization
Organization Name:SHELBY HOME & PUBLIC HEALTH, INC.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OFFICE MANAGER
Authorized Official - Prefix:MRS
Authorized Official - First Name:DANA
Authorized Official - Middle Name:J
Authorized Official - Last Name:WALLACE
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:419-342-6366
Mailing Address - Street 1:142 N GAMBLE ST
Mailing Address - Street 2:SUITE B
Mailing Address - City:SHELBY
Mailing Address - State:OH
Mailing Address - Zip Code:44875-2114
Mailing Address - Country:US
Mailing Address - Phone:419-342-6366
Mailing Address - Fax:419-342-4108
Practice Address - Street 1:142 N GAMBLE ST
Practice Address - Street 2:SUITE B
Practice Address - City:SHELBY
Practice Address - State:OH
Practice Address - Zip Code:44875-2114
Practice Address - Country:US
Practice Address - Phone:419-342-6366
Practice Address - Fax:419-342-4108
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2009-05-08
Last Update Date:2009-05-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes251E00000XAgenciesHome Health
Provider Identifiers
StateIdentifier IDID TypeIssuer
OH0053338Medicaid