Individual
LORENE MARIE WENTZ
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
F
Contact information
Practice address
9061 WHITE OAK DR, TWINSBURG, OH 44087-1757
(330) 998-4812
Mailing address
9061 WHITE OAK DR, TWINSBURG, OH 44087-1757
(330) 998-4812
Taxonomy
Speciality
Code
Description
License number
State
253Z00000X
In Home Supportive Care Agency
Primary
—
—
343900000X
Non-emergency Medical Transport (VAN)
RR240493
OH
347C00000X
Private Vehicle
RR240493
OH
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
7711097
WAIVER PROVIDER CONTRACT NUMBER
OH
Enumeration date
12/24/2020
Last updated
12/24/2020
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