Provider Demographics
NPI:1538470513
Name:DEAS, CELESTINE DJILE
Entity Type:Individual
Prefix:
First Name:CELESTINE
Middle Name:DJILE
Last Name:DEAS
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 1:3066 ENGLEWOOD DR
Mailing Address - Street 2:
Mailing Address - City:SILVER LAKE
Mailing Address - State:OH
Mailing Address - Zip Code:44224-3848
Mailing Address - Country:US
Mailing Address - Phone:330-285-1517
Mailing Address - Fax:
Practice Address - Street 1:3066 ENGLEWOOD DR
Practice Address - Street 2:
Practice Address - City:SILVER LAKE
Practice Address - State:OH
Practice Address - Zip Code:44224-3848
Practice Address - Country:US
Practice Address - Phone:330-285-1517
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2010-06-24
Last Update Date:2010-06-24
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OH322172510901376K00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes376K00000XNursing Service Related ProvidersNurse's Aide
Provider Identifiers
StateIdentifier IDID TypeIssuer
OH376K00000XMedicaid