Provider Demographics
NPI:1053154344
Name:CHILDERS, RUPERT ALLEN
Entity type:Individual
Prefix:
First Name:RUPERT
Middle Name:ALLEN
Last Name:CHILDERS
Suffix:
Gender:M
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:103 SCIOTO AVE
Mailing Address - Street 2:
Mailing Address - City:SOUTH POINT
Mailing Address - State:OH
Mailing Address - Zip Code:45680-9517
Mailing Address - Country:US
Mailing Address - Phone:304-638-1453
Mailing Address - Fax:
Practice Address - Street 1:103 SCIOTO AVE
Practice Address - Street 2:
Practice Address - City:SOUTH POINT
Practice Address - State:OH
Practice Address - Zip Code:45680-9517
Practice Address - Country:US
Practice Address - Phone:304-638-1453
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2024-06-14
Last Update Date:2024-06-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes374U00000XNursing Service Related ProvidersHome Health Aide