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Organization

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Active
Organization subpart
No

Provider details

NPI number
Authorized official
KRISTIN J FOX (DIRECTOR)
(513) 968-2757
Entity
Organization

Contact information

Practice address
7588 CENTRAL PARKE BLVD STE 102, MASON, OH 45040-6857
(515) 139-6827
Mailing address
7588 CENTRAL PARKE BLVD STE 102, MASON, OH 45040-6857
(515) 139-6827

Taxonomy

Speciality
Code
Description
License number
State
251C00000X
Developmentally Disabled Services Day Training Agency
Primary
253Z00000X
In Home Supportive Care Agency
343900000X
Non-emergency Medical Transport (VAN)
347C00000X
Private Vehicle
385HR2050X
Respite Care Camp
385HR2060X
Child Intellectual and/or Developmental Disabilities Respite Care

Other

Enumeration date
09/30/2024
Last updated
09/30/2024
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