Provider Demographics
NPI:1780179796
Name:VERO CUSTOM CONSTRUCTION
Entity Type:Organization
Organization Name:VERO CUSTOM CONSTRUCTION
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:MRS
Authorized Official - First Name:AMANDA
Authorized Official - Middle Name:M
Authorized Official - Last Name:NETHERLY
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:513-549-2710
Mailing Address - Street 1:289 JUPITER DR
Mailing Address - Street 2:
Mailing Address - City:CINCINNATI
Mailing Address - State:OH
Mailing Address - Zip Code:45238-6035
Mailing Address - Country:US
Mailing Address - Phone:513-703-8472
Mailing Address - Fax:
Practice Address - Street 1:289 JUPITER DR
Practice Address - Street 2:
Practice Address - City:CINCINNATI
Practice Address - State:OH
Practice Address - Zip Code:45238-6035
Practice Address - Country:US
Practice Address - Phone:513-703-8472
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2018-06-22
Last Update Date:2018-06-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OH201806900600305S00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes305S00000XManaged Care OrganizationsPoint of Service