Healthcare Provider Details

I. General information

NPI: 1396335493
Provider Name (Legal Business Name): LINCOLN HEIGHTS OUTREACH INCORPORATED
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 01/22/2021
Last Update Date: 01/22/2021
Certification Date: 01/07/2021
Deactivation Date:
Reactivation Date:

III. Provider practice location address

9931 WAYNE AVE
CINCINNATI OH
45215-1407
US

IV. Provider business mailing address

9931 WAYNE AVE
CINCINNATI OH
45215-1407
US

V. Phone/Fax

Practice location:
  • Phone: 513-744-6260
  • Fax: 513-769-8501
Mailing address:
  • Phone: 513-744-6260
  • Fax: 513-769-8501

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code261QA0600X
TaxonomyAdult Day Care Clinic/Center
License Number
License Number State

VIII. Authorized Official

Name: TEPHRA FIELDS
Title or Position: EXECUTIVE DIRECTOR
Credential:
Phone: 513-744-6260