Healthcare Provider Details

I. General information

NPI: 1639769680
Provider Name (Legal Business Name): NIKAS GROUP HOME LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 01/24/2021
Last Update Date: 02/04/2021
Certification Date: 02/04/2021
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2611 MONTANA AVE
CINCINNATI OH
45211-3768
US

IV. Provider business mailing address

PO BOX 58130
CINCINNATI OH
45258-0130
US

V. Phone/Fax

Practice location:
  • Phone: 513-244-1562
  • Fax:
Mailing address:
  • Phone: 513-244-1562
  • 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 Code322D00000X
TaxonomyEmotionally Disturbed Childrens' Residential Treatment Facility
License Number
License Number State

VIII. Authorized Official

Name: TANIKA PRICE
Title or Position: DIRECTOR
Credential:
Phone: 513-550-7449