Provider Demographics
NPI:1568067304
Name:MADACHIK, BARBARA JANE
Entity Type:Individual
Prefix:
First Name:BARBARA
Middle Name:JANE
Last Name:MADACHIK
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 1:14845 HOOVER RD
Mailing Address - Street 2:
Mailing Address - City:GARRETTSVILLE
Mailing Address - State:OH
Mailing Address - Zip Code:44231-9556
Mailing Address - Country:US
Mailing Address - Phone:330-631-5080
Mailing Address - Fax:
Practice Address - Street 1:120 MEADOWLANDS DR APT B1
Practice Address - Street 2:
Practice Address - City:CHARDON
Practice Address - State:OH
Practice Address - Zip Code:44024-9378
Practice Address - Country:US
Practice Address - Phone:330-631-5080
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2020-12-01
Last Update Date:2020-12-01
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes376J00000XNursing Service Related ProvidersHomemaker
Provider Identifiers
StateIdentifier IDID TypeIssuer
OHM2800900Medicaid