Healthcare Provider Details

I. General information

NPI: 1780286922
Provider Name (Legal Business Name): INCLUSIVE HOMECARE PROVIDER SERVICES
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 11/12/2020
Last Update Date: 11/12/2020
Certification Date: 11/10/2020
Deactivation Date:
Reactivation Date:

III. Provider practice location address

452 KINGS RUN DR
CINCINNATI OH
45232-1407
US

IV. Provider business mailing address

452 KINGS RUN DR
CINCINNATI OH
45232-1407
US

V. Phone/Fax

Practice location:
  • Phone: 786-830-3816
  • Fax:
Mailing address:
  • Phone: 786-830-3816
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code251B00000X
TaxonomyCase Management Agency
License Number
License Number StateNULL
# 2
Primary TaxonomyY
Taxonomy Code251E00000X
TaxonomyHome Health Agency
License Number
License Number StateNULL
# 3
Primary TaxonomyN
Taxonomy Code251K00000X
TaxonomyPublic Health or Welfare Agency
License Number
License Number StateNULL
# 4
Primary TaxonomyN
Taxonomy Code343900000X
TaxonomyNon-emergency Medical Transport (VAN)
License Number
License Number StateNULL
# 5
Primary TaxonomyN
Taxonomy Code174200000X
TaxonomyMeals Provider
License Number
License Number StateNULL

VIII. Authorized Official

Name: MICHAEL DANTE HIGGINS
Title or Position: CEO
Credential:
Phone: 786-830-3816