Healthcare Provider Details

I. General information

NPI: 1225809577
Provider Name (Legal Business Name): EXECUTIVE LONGTERM CARE CONSULTING
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 01/15/2024
Last Update Date: 01/15/2024
Certification Date: 01/14/2024
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2880 GROSVENOR DR
CINCINNATI OH
45251-1707
US

IV. Provider business mailing address

2880 GROSVENOR DR
CINCINNATI OH
45251-1707
US

V. Phone/Fax

Practice location:
  • Phone: 513-802-8573
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code251B00000X
TaxonomyCase Management Agency
License Number
License Number State
# 2
Primary TaxonomyN
Taxonomy Code251E00000X
TaxonomyHome Health Agency
License Number
License Number State
# 3
Primary TaxonomyN
Taxonomy Code251K00000X
TaxonomyPublic Health or Welfare Agency
License Number
License Number State
# 4
Primary TaxonomyN
Taxonomy Code251S00000X
TaxonomyCommunity/Behavioral Health Agency
License Number
License Number State
# 5
Primary TaxonomyN
Taxonomy Code253Z00000X
TaxonomyIn Home Supportive Care Agency
License Number
License Number State

VIII. Authorized Official

Name: MRS. DUNISHA JOHNSON
Title or Position: GERIATRIC CASE MANAGER
Credential: LNHA
Phone: 513-802-8573