Basic Information
Provider Information
NPI: 1184815250
EntityType: 1
ReplacementNPI:  
OrganizationName:  
LastName: TROYER
FirstName: JODY
MiddleName: S
NamePrefix:  
NameSuffix:  
Credential:  
OtherOrganizationName:  
OtherOrganizationType:  
OtherLastName:  
OtherFirstName:  
OtherMiddleName:  
OtherNamePrefix:  
OtherNameSuffix:  
OtherCredential:  
OtherLastNameType:  
Mailing Information
Address1: 4511 ROCKSIDE RD STE 330
Address2:  
City: INDEPENDENCE
State: OH
PostalCode: 441312157
CountryCode: US
TelephoneNumber: 2169010400
FaxNumber:  
Practice Location
Address1: 4511 ROCKSIDE RD STE 330
Address2:  
City: INDEPENDENCE
State: OH
PostalCode: 441312157
CountryCode: US
TelephoneNumber: 2169010400
FaxNumber:  
Other Information
ProviderEnumerationDate: 08/05/2007
LastUpdateDate: 08/05/2007
NPIDeactivationReasonCode:  
NPIDeactivationDate:  
NPIReactivationDate:  
ProviderGenderCode: M
AuthorizedOfficialLastName:  
AuthorizedOfficialFirstName:  
AuthorizedOfficialMiddleName:  
AuthorizedOfficialTitleorPosition:  
AuthorizedOfficialTelephone:  
IsSoleProprietor: Y
IsOrganizationSubpart:  
ParentOrganizationLBN:  
AuthorizedOfficialNamePrefix:  
AuthorizedOfficialNameSuffix:  
AuthorizedOfficialCredential:  
NPICertificationDate:  

Taxonomy Information
TaxonomyLicenseStateSwitchTaxonomyGroupTaxonomyTypeTaxonomyClassSubSpecialty
251E00000X06257OHY AgenciesHome Health 

No ID Information.


Home