Provider Demographics
NPI:1700018181
Name:BRUCE M RIDENOUR
Entity Type:Organization
Organization Name:BRUCE M RIDENOUR
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:CEO
Authorized Official - Prefix:MRS
Authorized Official - First Name:NAYESHA
Authorized Official - Middle Name:
Authorized Official - Last Name:WALKER-RIDENOUR
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:614-920-0434
Mailing Address - Street 1:5239 ALGEAN DR
Mailing Address - Street 2:
Mailing Address - City:CANAL WINCHESTER
Mailing Address - State:OH
Mailing Address - Zip Code:43110-8459
Mailing Address - Country:US
Mailing Address - Phone:614-920-0434
Mailing Address - Fax:614-920-0434
Practice Address - Street 1:5239 ALGEAN DR
Practice Address - Street 2:
Practice Address - City:CANAL WINCHESTER
Practice Address - State:OH
Practice Address - Zip Code:43110-8459
Practice Address - Country:US
Practice Address - Phone:614-920-0434
Practice Address - Fax:614-920-0434
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2009-08-18
Last Update Date:2009-10-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OH1874527251E00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes251E00000XAgenciesHome Health