Provider Demographics
NPI:1780280347
Name:BECKER, JEAN LOUISE (HOME CARE PROVIDER)
Entity type:Individual
Prefix:MS
First Name:JEAN
Middle Name:LOUISE
Last Name:BECKER
Suffix:
Gender:F
Credentials:HOME CARE PROVIDER
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:115 RIDGEVIEW DR
Mailing Address - Street 2:
Mailing Address - City:MEDINA
Mailing Address - State:OH
Mailing Address - Zip Code:44256-2918
Mailing Address - Country:US
Mailing Address - Phone:133-072-3776
Mailing Address - Fax:
Practice Address - Street 1:115 RIDGEVIEW DR
Practice Address - Street 2:
Practice Address - City:MEDINA
Practice Address - State:OH
Practice Address - Zip Code:44256-2918
Practice Address - Country:US
Practice Address - Phone:133-072-3776
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2020-12-09
Last Update Date:2020-12-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes374U00000XNursing Service Related ProvidersHome Health Aide
Provider Identifiers
StateIdentifier IDID TypeIssuer
OH2436582Medicaid