Provider Demographics
NPI:1790561645
Name:PRICE, TARA ELLEN
Entity Type:Individual
Prefix:
First Name:TARA
Middle Name:ELLEN
Last Name:PRICE
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:7326 STATE ROUTE 19 #3107
Mailing Address - Street 2:UNIT 8-125
Mailing Address - City:MT. GILEAD
Mailing Address - State:OH
Mailing Address - Zip Code:43338
Mailing Address - Country:US
Mailing Address - Phone:614-202-1200
Mailing Address - Fax:
Practice Address - Street 1:7326 STATE ROUTE 19 #3107
Practice Address - Street 2:UNIT 8-125
Practice Address - City:MT. GILEAD
Practice Address - State:OH
Practice Address - Zip Code:43338
Practice Address - Country:US
Practice Address - Phone:614-202-1200
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2023-09-06
Last Update Date:2023-09-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes253Z00000XAgenciesIn Home Supportive Care