Provider Demographics
NPI:1184352122
Name:CROUCH, RICKIE E SR
Entity type:Individual
Prefix:MR
First Name:RICKIE
Middle Name:E
Last Name:CROUCH
Suffix:SR
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 1:501 SCOTT ST
Mailing Address - Street 2:
Mailing Address - City:CRESTLINE
Mailing Address - State:OH
Mailing Address - Zip Code:44827-1548
Mailing Address - Country:US
Mailing Address - Phone:614-402-1270
Mailing Address - Fax:
Practice Address - Street 1:501 SCOTT ST
Practice Address - Street 2:
Practice Address - City:CRESTLINE
Practice Address - State:OH
Practice Address - Zip Code:44827-1548
Practice Address - Country:US
Practice Address - Phone:614-402-1270
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2022-08-09
Last Update Date:2022-08-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes372500000XNursing Service Related ProvidersChore Provider
No171WH0202XOther Service ProvidersContractorHome Modifications