Individual
TINA SIMS
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
F
Contact information
Practice address
9203 GRATIS JACKSONBURG RD, SOMERVILLE, OH 45064-9335
(937) 336-8416
Mailing address
9203 GRATIS JACKSONBURG RD, SOMERVILLE, OH 45064-9335
(937) 336-8416
Taxonomy
Speciality
Code
Description
License number
State
385HR2060X
Child Intellectual and/or Developmental Disabilities Respite Care
Primary
M6800288
OH
385HR2060X
Child Intellectual and/or Developmental Disabilities Respite Care
—
—
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
2715959
—
OH
Enumeration date
11/13/2020
Last updated
11/13/2020
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