MEDICARE: SHERRY CHILDERS

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	251B00000X	Case Management Agency

General Provider Information

NPI Number	:	1588444202
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	SHERRY CHILDERS

Provider Business Mailing Address
First Line	:	4561 ELIZABETH ST
Second Line	:
City	:	CINCINNATI
State	:	OH
Zip	:	45242-7821
Country	:	US
Telephone Number	:	513-628-4500
Fax Number	:

Provider Business Practice Location Address
First Line	:	4561 ELIZABETH ST
Second Line	:
City	:	CINCINNATI
State	:	OH
Zip	:	45242-7821
Country	:	US
Telephone Number	:	513-628-4500
Fax Number	:

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	10/02/2023
Last Update Date	:	10/02/2023

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Directions to “ SHERRY CHILDERS ” Practice Location

Language	Start Address	Practice Location

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