Provider Demographics
NPI:1457848137
Name:EASLEY, ERNEST EUGENE III
Entity Type:Individual
Prefix:MR
First Name:ERNEST
Middle Name:EUGENE
Last Name:EASLEY
Suffix:III
Gender:M
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:850 TORONTO AVE
Mailing Address - Street 2:
Mailing Address - City:TOLEDO
Mailing Address - State:OH
Mailing Address - Zip Code:43609-3046
Mailing Address - Country:US
Mailing Address - Phone:419-984-3174
Mailing Address - Fax:
Practice Address - Street 1:850 TORONTO AVE
Practice Address - Street 2:
Practice Address - City:TOLEDO
Practice Address - State:OH
Practice Address - Zip Code:43609-3046
Practice Address - Country:US
Practice Address - Phone:419-984-3174
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2018-04-18
Last Update Date:2018-04-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes251C00000XAgenciesDay Training, Developmentally Disabled Services
No253Z00000XAgenciesIn Home Supportive Care