Provider Demographics
NPI:1740525864
Name:DOUGS IN HOME ASSISTED LIVING LLC
Entity type:Organization
Organization Name:DOUGS IN HOME ASSISTED LIVING LLC
Other - Org Name:<UNAVAIL>
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:MR
Authorized Official - First Name:DOUGLAS
Authorized Official - Middle Name:RANDALL
Authorized Official - Last Name:POWELL
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:513-932-7001
Mailing Address - Street 1:3532 MARY ANN DR
Mailing Address - Street 2:
Mailing Address - City:LEBANON
Mailing Address - State:OH
Mailing Address - Zip Code:45036-1001
Mailing Address - Country:US
Mailing Address - Phone:513-932-7001
Mailing Address - Fax:513-932-7002
Practice Address - Street 1:3532 MARY ANN DR
Practice Address - Street 2:
Practice Address - City:LEBANON
Practice Address - State:OH
Practice Address - Zip Code:45036-1001
Practice Address - Country:US
Practice Address - Phone:513-932-7001
Practice Address - Fax:513-932-7002
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2012-11-29
Last Update Date:2012-11-29
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes253Z00000XAgenciesIn Home Supportive Care