Provider Demographics
NPI:1679179816
Name:SKALA, MARK SR
Entity Type:Individual
Prefix:
First Name:MARK
Middle Name:
Last Name:SKALA
Suffix:SR
Gender:M
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:911 CAROL CIR
Mailing Address - Street 2:
Mailing Address - City:ROSSFORD
Mailing Address - State:OH
Mailing Address - Zip Code:43460-1523
Mailing Address - Country:US
Mailing Address - Phone:419-461-2653
Mailing Address - Fax:
Practice Address - Street 1:911 CAROL CIR
Practice Address - Street 2:
Practice Address - City:ROSSFORD
Practice Address - State:OH
Practice Address - Zip Code:43460-1523
Practice Address - Country:US
Practice Address - Phone:419-461-2653
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2020-12-10
Last Update Date:2020-12-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes374U00000XNursing Service Related ProvidersHome Health Aide