Active NPI
Stephanie Pettaway
- In Home Supportive Care Agency
- Toledo, OH
National Provider Identifier
1649965120
On this page
Key facts
NPPES NPI Registry- Primary specialty
- In Home Supportive Care Agency
- Practice address
- 4903 Catalina Dr
Toledo, OH 43615-6115 - Phone
- (419) 578-8787
- NPI assigned
- Apr 10, 2023
- Sex
- Female
- Sole proprietor
- Yes
NPPES NPI Registry
Registry information is reported by the provider to CMS and is not verified. About this source
Specialties & licenses 2
| Specialty (taxonomy) | Code | License | State | Primary |
|---|---|---|---|---|
| Social Worker | 104100000X | S.2309637 | OH | |
| In Home Supportive Care Agency | 253Z00000X | OH | Primary |
Addresses
Primary practice location
4903 Catalina Dr
Toledo, OH 43615-6115
Mailing address
4903 Catalina Dr
Toledo, OH 43615-6115
Phone (419) 578-8787
Other identifiers 1
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 0497997 | Medicaid | OH |
Medicare participation
Medicare enrollment files- Medicare fee-for-service enrollment
- Not listed in the public Medicare enrollment file
National Provider Directory
National Provider Directory- Medicare enrollment (NPD)
- Not enrolled
State licenses
| License | State | Type | Specialty |
|---|---|---|---|
| S.2309637 | OH | MD | Social Worker |
NPI Registry JSON
The complete NPPES record for this NPI in the NPI Registry API format.
{
"created_epoch": "1681084800000",
"enumeration_type": "NPI-1",
"last_updated_epoch": "1727308800000",
"number": "1649965120",
"addresses": [
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "MAILING",
"address_type": "DOM",
"address_1": "4903 CATALINA DR",
"city": "TOLEDO",
"state": "OH",
"postal_code": "436156115",
"telephone_number": "419-578-8787",
"fax_number": "419-578-8787"
},
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "LOCATION",
"address_type": "DOM",
"address_1": "4903 CATALINA DR",
"city": "TOLEDO",
"state": "OH",
"postal_code": "436156115",
"telephone_number": "419-578-8787"
}
],
"practiceLocations": [],
"basic": {
"last_name": "PETTAWAY",
"first_name": "STEPHANIE",
"name_prefix": "Mrs.",
"sole_proprietor": "YES",
"sex": "F",
"enumeration_date": "2023-04-10",
"last_updated": "2024-09-26",
"certification_date": "2024-09-26",
"status": "A"
},
"taxonomies": [
{
"code": "104100000X",
"taxonomy_group": "",
"desc": "Social Worker",
"state": "OH",
"license": "S.2309637",
"primary": false
},
{
"code": "253Z00000X",
"taxonomy_group": "",
"desc": "In Home Supportive Care",
"state": "OH",
"license": null,
"primary": true
}
],
"identifiers": [
{
"code": "05",
"desc": "MEDICAID",
"issuer": null,
"identifier": "0497997",
"state": "OH"
}
],
"endpoints": [],
"other_names": []
}Other providers in Toledo, OH
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Sep 26, 2024; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.