Provider Demographics
NPI:1225736036
Name:VERZATILE LIFE
Entity Type:Organization
Organization Name:VERZATILE LIFE
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:CO-OWNER
Authorized Official - Prefix:MS
Authorized Official - First Name:KELLI
Authorized Official - Middle Name:
Authorized Official - Last Name:BIGBEE
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:937-305-5512
Mailing Address - Street 1:3618 SONORA PL
Mailing Address - Street 2:
Mailing Address - City:DAYTON
Mailing Address - State:OH
Mailing Address - Zip Code:45416-1134
Mailing Address - Country:US
Mailing Address - Phone:937-305-5512
Mailing Address - Fax:
Practice Address - Street 1:3618 SONORA PL
Practice Address - Street 2:
Practice Address - City:DAYTON
Practice Address - State:OH
Practice Address - Zip Code:45416-1134
Practice Address - Country:US
Practice Address - Phone:937-305-5512
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2023-02-21
Last Update Date:2023-02-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes376J00000XNursing Service Related ProvidersHomemakerGroup - Single Specialty