MEDICARE: MS. CHRISTINE TITUS

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	:	1790508836
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	MS. CHRISTINE TITUS

Provider Business Mailing Address
First Line	:	17403 WICK AVE
Second Line	:
City	:	LAKE MILTON
State	:	OH
Zip	:	44429-9772
Country	:	US
Telephone Number	:	330-881-8155
Fax Number	:

Provider Business Practice Location Address
First Line	:	17403 WICK AVE
Second Line	:
City	:	LAKE MILTON
State	:	OH
Zip	:	44429-9772
Country	:	US
Telephone Number	:	330-881-8155
Fax Number	:

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

Provider Enumeration Date	:	11/06/2024
Last Update Date	:	11/06/2024

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