Jennifer Deforest

Primary specialty

Intellectual and/or Developmental Disabilities Community Based Residential Treatment FacilityTaxonomy code 320900000X

License

8701195 Issued in OH

Practice address

3 Coventry LN
Athens, OH 45701-3717

Phone

(740) 707-1691

NPI assigned

Jan 2, 2021

Sex

Female

Sole proprietor

Yes

Registry information is reported by the provider to CMS and is not verified. About this source

Specialties & licenses 2

Addresses

Other identifiers 1

Other names 1

• Jennifer Grills Former name

Medicare fee-for-service enrollment

Not listed in the public Medicare enrollment file

Medicare enrollment (NPD)

Not enrolled

State licenses

The complete NPPES record for this NPI in the NPI Registry API format.

{
    "created_epoch": "1609545600000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1609545600000",
    "number": "1548858939",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "11447 VALLEY DR",
            "city": "THE PLAINS",
            "state": "OH",
            "postal_code": "457801428",
            "telephone_number": "740-707-1691"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "3 COVENTRY LN",
            "city": "ATHENS",
            "state": "OH",
            "postal_code": "457013717",
            "telephone_number": "740-707-1691"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "DEFOREST",
        "first_name": "JENNIFER",
        "sole_proprietor": "YES",
        "sex": "F",
        "enumeration_date": "2021-01-02",
        "last_updated": "2021-01-02",
        "certification_date": "2021-01-02",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "320900000X",
            "taxonomy_group": "",
            "desc": "Community Based Residential Treatment Facility, Intellectual and/or Developmental Disabilities",
            "state": null,
            "license": null,
            "primary": false
        },
        {
            "code": "320900000X",
            "taxonomy_group": "",
            "desc": "Community Based Residential Treatment Facility, Intellectual and/or Developmental Disabilities",
            "state": "OH",
            "license": "8701195",
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "0427093",
            "state": "OH"
        }
    ],
    "endpoints": [],
    "other_names": [
        {
            "first_name": "JENNIFER",
            "last_name": "GRILLS",
            "code": "1",
            "type": "Former Name"
        }
    ]
}

• Christine Renee Dearth
• Bernhard S Debatin, CT
• Douglas Debrick, LPC
• Patricia Lynne Debruin, CNP
• Ashley Deem
• Lauren Delancey
• Melody Delaney
• Bonnie H Delange, LPCC-S
• William Delawder III
• Olivia E Demaree

• Intellectual and/or Developmental Disabilities Community Based Residential Treatment Facility in Athens, OH
• Providers in Athens, OH by specialty
• Intellectual and/or Developmental Disabilities Community Based Residential Treatment Facility in Ohio

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Jan 2, 2021; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
• National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.