MEDICARE: CLARA'S HEART M.R.D.D. SERVICES 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	253Z00000X	In Home Supportive Care Agency

General Provider Information

NPI Number	:	1386168300
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	CLARA'S HEART M.R.D.D. SERVICES LLC

Provider Business Mailing Address
First Line	:	4523 BLUE LARGO CT
Second Line	:
City	:	COLUMBUS
State	:	OH
Zip	:	43230-2091
Country	:	US
Telephone Number	:	614-975-6126
Fax Number	:

Provider Business Practice Location Address
First Line	:	4523 BLUE LARGO CT
Second Line	:
City	:	COLUMBUS
State	:	OH
Zip	:	43230-2091
Country	:	US
Telephone Number	:	614-975-6126
Fax Number	:

Authorized Official
Title or Position	:	OWNER/PRESIDENT
Name	:	TAYNA JOHNSON
Credential	:
Telephone Number	:	614-975-6126

Provider Enumeration Date	:	08/01/2017
Last Update Date	:	07/21/2022

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