Organization
OHIO HOME CARE PROGRAM
Active
Organization subpart
No
Provider details
NPI number
Authorized official
MRS. KAREN ELAINE WALLRT LPN (LPN)
(740) 858-2828
Entity
Organization
Contact information
Practice address
613 JETT ST, WEST PORTSMOUTH, OH 45663-6213
(740) 858-2828
Mailing address
613 JETT ST, WEST PORTSMOUTH, OH 45663-6213
(740) 858-2828
Taxonomy
Speciality
Code
Description
License number
State
305R00000X
Preferred Provider Organization
Primary
PN 113668
OH
Other
Enumeration date
11/12/2007
Last updated
11/12/2007
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