Provider Demographics
NPI:1508971839
Name:THE HEALTHY DIABETIC
Entity Type:Organization
Organization Name:THE HEALTHY DIABETIC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:MANAGING MEMBER
Authorized Official - Prefix:
Authorized Official - First Name:BEVERLY
Authorized Official - Middle Name:SUE
Authorized Official - Last Name:RISNER
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:513-248-8250
Mailing Address - Street 1:1000 FORD CIR
Mailing Address - Street 2:SUITE B
Mailing Address - City:MILFORD
Mailing Address - State:OH
Mailing Address - Zip Code:45150-2732
Mailing Address - Country:US
Mailing Address - Phone:513-248-8250
Mailing Address - Fax:
Practice Address - Street 1:1000 FORD CIR
Practice Address - Street 2:SUITE B
Practice Address - City:MILFORD
Practice Address - State:OH
Practice Address - Zip Code:45150-2732
Practice Address - Country:US
Practice Address - Phone:513-248-8250
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-08-19
Last Update Date:2020-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OH1278917332B00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes332B00000XSuppliersDurable Medical Equipment & Medical Supplies
Provider Identifiers
StateIdentifier IDID TypeIssuer
OH2294182Medicaid
OH2294182Medicaid