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Organization

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Active
Organization subpart
No

Provider details

NPI number
Authorized official
REGINA SHIELDS (CHIEF EXECUTIVE DIRECTOR)
(513) 373-0405
Entity
Organization

Contact information

Practice address
4373 W 8TH ST, SUIT 17, CINCINNATI, OH 45205-2066
(877) 770-5282
(877) 694-3466
Mailing address
PO BOX 11034, CINCINNATI, OH 45211-0034
(877) 770-5282
(877) 694-3466

Taxonomy

Speciality
Code
Description
License number
State
251B00000X
Case Management Agency
251J00000X
Nursing Care Agency
251V00000X
Voluntary or Charitable Agency
253Z00000X
In Home Supportive Care Agency
Primary
302R00000X
Health Maintenance Organization
305S00000X
Point of Service
3104A0625X
Assisted Living Facility (Mental Illness)
3104A0630X
Assisted Living Facility (Behavioral Disturbances)
332U00000X
Home Delivered Meals

Other

Enumeration date
07/19/2012
Last updated
07/19/2012
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