Provider Demographics
NPI:1164545786
Name:SAMS, CHARLENE K
Entity Type:Individual
Prefix:MRS
First Name:CHARLENE
Middle Name:K
Last Name:SAMS
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 1:3840 STATE ROUTE 772
Mailing Address - Street 2:
Mailing Address - City:CHILLICOTHE
Mailing Address - State:OH
Mailing Address - Zip Code:45601-8964
Mailing Address - Country:US
Mailing Address - Phone:740-663-5066
Mailing Address - Fax:
Practice Address - Street 1:14191 STATE ROUTE 772
Practice Address - Street 2:
Practice Address - City:CHILLICOTHE
Practice Address - State:OH
Practice Address - Zip Code:45601-9101
Practice Address - Country:US
Practice Address - Phone:740-774-1323
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2007-04-09
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OH2620033374U00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes374U00000XNursing Service Related ProvidersHome Health Aide
Provider Identifiers
StateIdentifier IDID TypeIssuer
OH2620033Medicare ID - Type UnspecifiedHOME HEALTH AIDE