Provider Demographics
NPI:1023748282
Name:LUCAS, ROSE
Entity type:Individual
Prefix:
First Name:ROSE
Middle Name:
Last Name:LUCAS
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 1:1855 STATE ROUTE 152
Mailing Address - Street 2:
Mailing Address - City:DILLONVALE
Mailing Address - State:OH
Mailing Address - Zip Code:43917-7927
Mailing Address - Country:US
Mailing Address - Phone:740-381-1785
Mailing Address - Fax:
Practice Address - Street 1:1855 STATE ROUTE 152
Practice Address - Street 2:
Practice Address - City:DILLONVALE
Practice Address - State:OH
Practice Address - Zip Code:43917-7927
Practice Address - Country:US
Practice Address - Phone:740-381-1785
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2022-06-12
Last Update Date:2022-06-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OH00003053403747P1801X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes3747P1801XNursing Service Related ProvidersTechnicianPersonal Care Attendant