Provider Demographics
NPI:1790369031
Name:JARRELL, MAX C
Entity Type:Individual
Prefix:
First Name:MAX
Middle Name:C
Last Name:JARRELL
Suffix:
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 1:710 EAGLEVIEW CT
Mailing Address - Street 2:
Mailing Address - City:MASON
Mailing Address - State:OH
Mailing Address - Zip Code:45040-2048
Mailing Address - Country:US
Mailing Address - Phone:513-225-8973
Mailing Address - Fax:
Practice Address - Street 1:710 EAGLEVIEW CT
Practice Address - Street 2:
Practice Address - City:MASON
Practice Address - State:OH
Practice Address - Zip Code:45040-2048
Practice Address - Country:US
Practice Address - Phone:513-225-8973
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2021-05-12
Last Update Date:2021-05-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes376J00000XNursing Service Related ProvidersHomemaker
No3747P1801XNursing Service Related ProvidersTechnicianPersonal Care Attendant