Provider Demographics
NPI:1649612813
Name:THE ULTIMATE SERVANT HOME CARE SOLUTION LLC.
Entity type:Organization
Organization Name:THE ULTIMATE SERVANT HOME CARE SOLUTION LLC.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:SOLE PROPRIETOR
Authorized Official - Prefix:
Authorized Official - First Name:CLARA-DENISE
Authorized Official - Middle Name:
Authorized Official - Last Name:COBB
Authorized Official - Suffix:
Authorized Official - Credentials:MED
Authorized Official - Phone:937-610-2422
Mailing Address - Street 1:1576 CORNELL DR
Mailing Address - Street 2:
Mailing Address - City:DAYTON
Mailing Address - State:OH
Mailing Address - Zip Code:45406-4728
Mailing Address - Country:US
Mailing Address - Phone:937-610-2422
Mailing Address - Fax:
Practice Address - Street 1:1576 CORNELL DR
Practice Address - Street 2:
Practice Address - City:DAYTON
Practice Address - State:OH
Practice Address - Zip Code:45406-4728
Practice Address - Country:US
Practice Address - Phone:937-610-2422
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2013-07-29
Last Update Date:2013-07-29
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes251E00000XAgenciesHome Health