Healthcare Provider Details

I. General information

NPI: 1164055711
Provider Name (Legal Business Name): DEDICATED OHIO HOLDING, LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 02/21/2020
Last Update Date: 02/21/2020
Certification Date: 02/21/2020
Deactivation Date:
Reactivation Date:

III. Provider practice location address

7642 READING RD
CINCINNATI OH
45237-3204
US

IV. Provider business mailing address

1395 NW 167TH ST
MIAMI FL
33169-5710
US

V. Phone/Fax

Practice location:
  • Phone: 513-619-7766
  • Fax:
Mailing address:
  • Phone: 305-628-6117
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code332900000X
TaxonomyNon-Pharmacy Dispensing Site
License Number
License Number State

VIII. Authorized Official

Name: MARY CHEN
Title or Position: OWNER
Credential:
Phone: 305-628-6117