Healthcare Provider Details

I. General information

NPI: 1710262050
Provider Name (Legal Business Name): CRITICAL CARE HOME CARE
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 10/19/2011
Last Update Date: 10/19/2011
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

412 ELM ST
CINCINNATI OH
45238-5410
US

IV. Provider business mailing address

412 ELM ST
CINCINNATI OH
45238-5410
US

V. Phone/Fax

Practice location:
  • Phone: 513-446-2686
  • Fax:
Mailing address:
  • Phone: 513-446-2686
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code251E00000X
TaxonomyHome Health Agency
License NumberRN 320480
License Number StateOH
# 2
Primary TaxonomyN
Taxonomy Code251J00000X
TaxonomyNursing Care Agency
License NumberRN 320480
License Number StateOH

VIII. Authorized Official

Name: JUDY HANDSHOE
Title or Position: OWNER
Credential:
Phone: 513-446-2686