Rickey Tackett Jr.
Individual provider Active NPI Home Health Aide · Lodi, OH
NPI 1336717388 · NPPES record last updated Jun 16, 2021
Key facts
- NPI
- 1336717388
- Entity type
- Individual (NPI type 1)
- Primary specialty
- Home Health Aide 374U00000X
- Practice address
- 130 River St
Lodi, OH 44254-1045 - Phone
- (330) 441-0030
- NPI assigned
- Jun 16, 2021
- Sex
- Male
- 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 |
|---|---|---|---|---|
| Home Health Aide | 374U00000X | Yes |
Addresses
Primary practice location
130 River St
Lodi, OH 44254-1045
Mailing address
130 River St
Lodi, OH 44254-1045
Other providers in Lodi, OH
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Record last updated by the provider on Jun 16, 2021. 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.