Provider Demographics
NPI:1134390107
Name:DS MALE GROUP HOME FAMILY HOME
Entity type:Organization
Organization Name:DS MALE GROUP HOME FAMILY HOME
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:MS
Authorized Official - First Name:YOLANDA
Authorized Official - Middle Name:DEANNE
Authorized Official - Last Name:DABNEY
Authorized Official - Suffix:
Authorized Official - Credentials:RN
Authorized Official - Phone:419-932-4959
Mailing Address - Street 1:1214 PECK STREET
Mailing Address - Street 2:
Mailing Address - City:TOLEDO
Mailing Address - State:OH
Mailing Address - Zip Code:43608
Mailing Address - Country:US
Mailing Address - Phone:419-932-4959
Mailing Address - Fax:
Practice Address - Street 1:1214 PECK STREET
Practice Address - Street 2:
Practice Address - City:TOLEDO
Practice Address - State:OH
Practice Address - Zip Code:43608
Practice Address - Country:US
Practice Address - Phone:419-243-8534
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2008-03-18
Last Update Date:2008-03-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OH251E00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes251E00000XAgenciesHome Health