Provider Demographics
NPI:1871108449
Name:DEPENDABLE CARE TRAVELING NP LLC
Entity type:Organization
Organization Name:DEPENDABLE CARE TRAVELING NP LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER/PROVIDER
Authorized Official - Prefix:MISS
Authorized Official - First Name:POROTHEA
Authorized Official - Middle Name:LYNNETTE
Authorized Official - Last Name:DENNIS
Authorized Official - Suffix:
Authorized Official - Credentials:NP
Authorized Official - Phone:937-974-9398
Mailing Address - Street 1:PO BOX 594
Mailing Address - Street 2:
Mailing Address - City:DAYTON
Mailing Address - State:OH
Mailing Address - Zip Code:45401-0594
Mailing Address - Country:US
Mailing Address - Phone:937-422-8128
Mailing Address - Fax:
Practice Address - Street 1:33 DAYTON AVE
Practice Address - Street 2:
Practice Address - City:DAYTON
Practice Address - State:OH
Practice Address - Zip Code:45402-6402
Practice Address - Country:US
Practice Address - Phone:937-974-9398
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2020-09-10
Last Update Date:2020-09-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes251K00000XAgenciesPublic Health or Welfare
No251E00000XAgenciesHome Health
No251J00000XAgenciesNursing Care
Provider Identifiers
StateIdentifier IDID TypeIssuer
OH1659771673Medicaid
OH1659771673OtherMEDICARE