Tracey Leh Davis, SHARED LIVING
Individual provider Active NPI Child Intellectual and/or Developmental Disabilities Respite Care · Wellston, OH
NPI 1053916338 · NPPES record last updated Dec 3, 2020
Key facts
- NPI
- 1053916338
- Entity type
- Individual (NPI type 1)
- Primary specialty
- Child Intellectual and/or Developmental Disabilities Respite Care 385HR2060X
- Practice address
- 207 Melvin Downard Rd
Wellston, OH 45692-9232 - Phone
- (740) 988-8400
- NPI assigned
- Dec 3, 2020
- Sex
- Female
- Sole proprietor
- Yes
Medicare participation
- Medicare fee-for-service enrollment
- Not listed in the public Medicare enrollment file
National Provider Directory
- Medicare enrollment (NPD)
- No
Specialties & licenses
| Specialty (taxonomy) | Code | License | State | Primary |
|---|---|---|---|---|
| Child Intellectual and/or Developmental Disabilities Respite Care | 385HR2060X | Yes |
Addresses
Primary practice location
207 Melvin Downard Rd
Wellston, OH 45692-9232
Mailing address
207 Melvin Downard Rd
Wellston, OH 45692-9232
Phone (740) 988-8400
Other identifiers
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 105257068499 | Medicaid | OH |
Other providers in Wellston, OH
- Pamela Kay Colmer
- Ella Conley
- Jessica Lynn Cox
- Ryan Darnell
- Jennifer Mary Davis
- Jennifer Delong
- Teena Elaine Dickson
- Tiffany Diddle
- April Dawn Doles
- Katelynn Downard
All providers in Wellston, OH · Child Intellectual and/or Developmental Disabilities Respite Care in Ohio
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Record last updated by the provider on Dec 3, 2020. Information in NPPES is self-reported and not verified by CMS.
- NUCC Health Care Provider Taxonomy: specialty names.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.