MEDICARE: GIFTEDSOULS513 LIMITED LIABILITY COMPANY

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	251E00000X	Home Health Agency

General Provider Information

NPI Number	:	1144051129
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	GIFTEDSOULS513 LIMITED LIABILITY COMPANY

Provider Business Mailing Address
First Line	:	3190 MCHENRY AVE
Second Line	:
City	:	CINCINNATI
State	:	OH
Zip	:	45211-7343
Country	:	US
Telephone Number	:	513-375-8984
Fax Number	:

Provider Business Practice Location Address
First Line	:	3190 MCHENRY AVE
Second Line	:
City	:	CINCINNATI
State	:	OH
Zip	:	45211-7343
Country	:	US
Telephone Number	:	513-375-8984
Fax Number	:

Authorized Official
Title or Position	:	OWNER
Name	:	MIRANDA MAE MUSE
Credential	:	CERTIFIED NURSE AIDE
Telephone Number	:	513-375-8984

Provider Enumeration Date	:	08/12/2024
Last Update Date	:	08/12/2024

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