Provider Demographics
NPI:1558564369
Name:PRIVATE DUTY SERVICES INC
Entity Type:Organization
Organization Name:PRIVATE DUTY SERVICES INC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:MR
Authorized Official - First Name:BRENT
Authorized Official - Middle Name:
Authorized Official - Last Name:TOW
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:419-238-9223
Mailing Address - Street 1:1157 WESTWOOD DR
Mailing Address - Street 2:
Mailing Address - City:VAN WERT
Mailing Address - State:OH
Mailing Address - Zip Code:45891-2464
Mailing Address - Country:US
Mailing Address - Phone:419-238-9223
Mailing Address - Fax:419-238-9391
Practice Address - Street 1:1157 WESTWOOD DR
Practice Address - Street 2:
Practice Address - City:VAN WERT
Practice Address - State:OH
Practice Address - Zip Code:45891-2464
Practice Address - Country:US
Practice Address - Phone:419-238-9223
Practice Address - Fax:419-238-9391
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-06-08
Last Update Date:2008-04-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes251E00000XAgenciesHome Health
Provider Identifiers
StateIdentifier IDID TypeIssuer
OH=========OtherHOME HEALTH AGENCY