MEDICARE: JEDIDJAH ALEXANDRE

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	374U00000X	Home Health Aide

General Provider Information

NPI Number	:	1780364372
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	JEDIDJAH ALEXANDRE

Provider Business Mailing Address
First Line	:	3420 QUINLAN BLVD
Second Line	:
City	:	CANAL WINCHESTER
State	:	OH
Zip	:	43110-9120
Country	:	US
Telephone Number	:	380-228-5717
Fax Number	:

Provider Business Practice Location Address
First Line	:	3420 QUINLAN BLVD
Second Line	:
City	:	CANAL WINCHESTER
State	:	OH
Zip	:	43110-9120
Country	:	US
Telephone Number	:	380-228-5717
Fax Number	:

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

Provider Enumeration Date	:	07/19/2023
Last Update Date	:	07/19/2023

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Directions to “ JEDIDJAH ALEXANDRE ” Practice Location

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