MEDICARE: HONOR WITH CLASS 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	253Z00000X	In Home Supportive Care Agency		OH

General Provider Information

NPI Number	:	1821334939
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	HONOR WITH CLASS LLC

Provider Business Mailing Address
First Line	:	7839 LINCOLN AVE APT 1
Second Line	:
City	:	CINCINNATI
State	:	OH
Zip	:	45231-3179
Country	:	US
Telephone Number	:	513-628-8177
Fax Number	:

Provider Business Practice Location Address
First Line	:	7839 LINCOLN AVE APT 1
Second Line	:
City	:	CINCINNATI
State	:	OH
Zip	:	45231-3179
Country	:	US
Telephone Number	:	513-628-8177
Fax Number	:

Authorized Official
Title or Position	:	CEO
Name	:	MS. IVYE MARIE GARDNER
Credential	:	LSW
Telephone Number	:	513-628-8177

Provider Enumeration Date	:	12/17/2012
Last Update Date	:	12/17/2012

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