Provider Demographics
NPI:1700634185
Name:HACKWORTH, REBECCA
Entity Type:Individual
Prefix:
First Name:REBECCA
Middle Name:
Last Name:HACKWORTH
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 1:810 CEDAR RUN RD
Mailing Address - Street 2:
Mailing Address - City:BLUE CREEK
Mailing Address - State:OH
Mailing Address - Zip Code:45616-9721
Mailing Address - Country:US
Mailing Address - Phone:937-798-0168
Mailing Address - Fax:
Practice Address - Street 1:810 CEDAR RUN RD
Practice Address - Street 2:
Practice Address - City:BLUE CREEK
Practice Address - State:OH
Practice Address - Zip Code:45616-9721
Practice Address - Country:US
Practice Address - Phone:937-798-0168
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2024-05-09
Last Update Date:2024-05-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes374U00000XNursing Service Related ProvidersHome Health Aide
No376J00000XNursing Service Related ProvidersHomemaker
No385H00000XRespite Care FacilityRespite Care