Organization
EXECUTIVE HERITAGE'S ASSISTED LIVING, INC
Active
Organization subpart
No
Provider details
NPI number
Authorized official
AMANUEL DANIACHEW MD (OWNER)
(619) 403-6906
Entity
Organization
Contact information
Practice address
4050 EXECUTIVE PARK DR STE 240, CINCINNATI, OH 45241-2094
(513) 518-4631
Mailing address
4050 EXECUTIVE PARK DR STE 240, CINCINNATI, OH 45241-2094
(513) 518-4631
Taxonomy
Speciality
Code
Description
License number
State
251S00000X
Community/Behavioral Health Agency
—
—
253Z00000X
In Home Supportive Care Agency
Primary
—
—
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
0229867
—
OH
Enumeration date
10/14/2020
Last updated
10/14/2020
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