Provider Demographics
NPI:1902668502
Name:HALL, CAROL
Entity Type:Individual
Prefix:
First Name:CAROL
Middle Name:
Last Name:HALL
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:5203 ALVA AVE NW
Mailing Address - Street 2:
Mailing Address - City:WARREN
Mailing Address - State:OH
Mailing Address - Zip Code:44483-1211
Mailing Address - Country:US
Mailing Address - Phone:440-563-6410
Mailing Address - Fax:
Practice Address - Street 1:132 SHADY LANE CIR NE
Practice Address - Street 2:
Practice Address - City:WARREN
Practice Address - State:OH
Practice Address - Zip Code:44483-3536
Practice Address - Country:US
Practice Address - Phone:440-563-6410
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2024-01-29
Last Update Date:2024-01-29
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes172A00000XOther Service ProvidersDriverGroup - Multi-Specialty
No251E00000XAgenciesHome Health