MEDICARE: HERSON LLC

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	:	1265977748
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	HERSON LLC

Provider Business Mailing Address
First Line	:	1423 W GRAND AVE
Second Line	:
City	:	DAYTON
State	:	OH
Zip	:	45402-6037
Country	:	US
Telephone Number	:	937-824-0076
Fax Number	:

Provider Business Practice Location Address
First Line	:	1423 W GRAND AVE
Second Line	:
City	:	DAYTON
State	:	OH
Zip	:	45402-6037
Country	:	US
Telephone Number	:	937-824-0076
Fax Number	:

Authorized Official
Title or Position	:	CEO
Name	:	ELIZA HERALD
Credential	:	REGISTERED NURSE
Telephone Number	:	937-824-0076

Provider Enumeration Date	:	12/20/2016
Last Update Date	:	12/20/2016

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Directions to “HERSON LLC ” Practice Location

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