Provider Demographics
NPI:1114178118
Name:DEMETRIUS OF FORTY CHURCHES LLC
Entity Type:Organization
Organization Name:DEMETRIUS OF FORTY CHURCHES LLC
Other - Org Name:AHLERS MEALS
Other - Org Type:Doing Business As
Authorized Official - Title/Position:GENERAL MANAGER
Authorized Official - Prefix:MRS
Authorized Official - First Name:LINDSEY
Authorized Official - Middle Name:
Authorized Official - Last Name:CHERRY
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:937-506-8487
Mailing Address - Street 1:3620 LIGHTNER RD
Mailing Address - Street 2:
Mailing Address - City:VANDALIA
Mailing Address - State:OH
Mailing Address - Zip Code:45377-9569
Mailing Address - Country:US
Mailing Address - Phone:937-506-8487
Mailing Address - Fax:937-506-8490
Practice Address - Street 1:3620 LIGHTNER RD
Practice Address - Street 2:
Practice Address - City:VANDALIA
Practice Address - State:OH
Practice Address - Zip Code:45377-9569
Practice Address - Country:US
Practice Address - Phone:937-506-8487
Practice Address - Fax:937-506-8490
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2008-10-08
Last Update Date:2020-05-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OH20080989332U00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes332U00000XSuppliersHome Delivered Meals