Provider Demographics
NPI:1942324785
Name:HOME DELIVERED MEALS
Entity Type:Organization
Organization Name:HOME DELIVERED MEALS
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:BILLING CLERK
Authorized Official - Prefix:MRS
Authorized Official - First Name:REBECCA
Authorized Official - Middle Name:DAWN
Authorized Official - Last Name:FREMONT
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:740-820-8628
Mailing Address - Street 1:2184 STOCKDALE RD
Mailing Address - Street 2:
Mailing Address - City:BEAVER
Mailing Address - State:OH
Mailing Address - Zip Code:45613-9448
Mailing Address - Country:US
Mailing Address - Phone:740-820-8628
Mailing Address - Fax:
Practice Address - Street 1:2184 STOCKDALE RD
Practice Address - Street 2:
Practice Address - City:BEAVER
Practice Address - State:OH
Practice Address - Zip Code:45613-9448
Practice Address - Country:US
Practice Address - Phone:740-820-8628
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-03-19
Last Update Date:2020-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes332U00000XSuppliersHome Delivered Meals
Provider Identifiers
StateIdentifier IDID TypeIssuer
OH0247914Medicare UPIN