MEDICARE: THE ULTIMATE SERVANT HOME CARE SOLUTION 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	:	1649612813
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	THE ULTIMATE SERVANT HOME CARE SOLUTION LLC.

Provider Business Mailing Address
First Line	:	1576 CORNELL DR
Second Line	:
City	:	DAYTON
State	:	OH
Zip	:	45406-4728
Country	:	US
Telephone Number	:	937-610-2422
Fax Number	:

Provider Business Practice Location Address
First Line	:	1576 CORNELL DR
Second Line	:
City	:	DAYTON
State	:	OH
Zip	:	45406-4728
Country	:	US
Telephone Number	:	937-610-2422
Fax Number	:

Authorized Official
Title or Position	:	SOLE PROPRIETOR
Name	:	CLARA-DENISE COBB
Credential	:	M.ED
Telephone Number	:	937-610-2422

Provider Enumeration Date	:	07/29/2013
Last Update Date	:	07/29/2013

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