Healthcare Provider Details

I. General information

NPI: 1669083697
Provider Name (Legal Business Name): EXAPTIONAL SENIOR CARE
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 08/13/2020
Last Update Date: 08/13/2020
Certification Date: 08/13/2020
Deactivation Date:
Reactivation Date:

III. Provider practice location address

7373 BROOK CREST RD 342
CINCINNATI OH
45237
US

IV. Provider business mailing address

7373 BROOK CREST RD 342
CINCINNATI OH
45237
US

V. Phone/Fax

Practice location:
  • Phone: 513-832-3024
  • Fax: 513-832-3023
Mailing address:
  • Phone: 513-832-3024
  • Fax: 513-832-3023

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code251E00000X
TaxonomyHome Health Agency
License Number
License Number State
# 2
Primary TaxonomyN
Taxonomy Code251J00000X
TaxonomyNursing Care Agency
License Number
License Number State

VIII. Authorized Official

Name: JAVONTE LISA AVERY
Title or Position: LPN
Credential: LPN
Phone: 513-501-0211