MEDICARE: KEAUNA JOY MCCLAIN

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	401495990313	OH

General Provider Information

NPI Number	:	1669238846
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	KEAUNA JOY MCCLAIN

Provider Business Mailing Address
First Line	:	4201 MIDWAY AVE
Second Line	:
City	:	DAYTON
State	:	OH
Zip	:	45417-1313
Country	:	US
Telephone Number	:	937-759-7111
Fax Number	:

Provider Business Practice Location Address
First Line	:	4201 MIDWAY AVE
Second Line	:
City	:	DAYTON
State	:	OH
Zip	:	45417-1313
Country	:	US
Telephone Number	:	937-759-7111
Fax Number	:

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

Provider Enumeration Date	:	02/26/2024
Last Update Date	:	02/26/2024

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