Provider Demographics
NPI:1578811659
Name:PEDIATRIC HOME CARE
Entity Type:Organization
Organization Name:PEDIATRIC HOME CARE
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:ADMINISTRAITOR
Authorized Official - Prefix:MR
Authorized Official - First Name:TIMOTHY
Authorized Official - Middle Name:
Authorized Official - Last Name:PAVEY
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:740-505-8271
Mailing Address - Street 1:717 N NORTH ST
Mailing Address - Street 2:
Mailing Address - City:WASHINGTON COURT HOUSE
Mailing Address - State:OH
Mailing Address - Zip Code:43160-1466
Mailing Address - Country:US
Mailing Address - Phone:740-505-8271
Mailing Address - Fax:
Practice Address - Street 1:717 N NORTH ST
Practice Address - Street 2:
Practice Address - City:WASHINGTON COURT HOUSE
Practice Address - State:OH
Practice Address - Zip Code:43160-1466
Practice Address - Country:US
Practice Address - Phone:740-505-8271
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2012-08-21
Last Update Date:2012-08-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes251E00000XAgenciesHome Health