Provider Demographics
NPI:1619561347
Name:SHUMWAY, DIXIE ELAINE (CEO)
Entity Type:Individual
Prefix:
First Name:DIXIE
Middle Name:ELAINE
Last Name:SHUMWAY
Suffix:
Gender:F
Credentials:CEO
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:510 S STATE ST STE B
Mailing Address - Street 2:
Mailing Address - City:HARRISON
Mailing Address - State:OH
Mailing Address - Zip Code:45030-1494
Mailing Address - Country:US
Mailing Address - Phone:513-715-1189
Mailing Address - Fax:513-282-4395
Practice Address - Street 1:510 S STATE ST STE B
Practice Address - Street 2:
Practice Address - City:HARRISON
Practice Address - State:OH
Practice Address - Zip Code:45030-1494
Practice Address - Country:US
Practice Address - Phone:513-715-1189
Practice Address - Fax:513-282-4395
Is Sole Proprietor?:Yes
Enumeration Date:2021-02-23
Last Update Date:2021-02-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OH385H00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes385H00000XRespite Care FacilityRespite Care