Healthcare Provider Details

I. General information

NPI: 1528878808
Provider Name (Legal Business Name): ADAPTIVE LIVING LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 01/09/2025
Last Update Date: 09/19/2025
Certification Date: 09/19/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1717 SECTION RD STE 213
CINCINNATI OH
45237-3336
US

IV. Provider business mailing address

1717 SECTION RD STE 213
CINCINNATI OH
45237-3336
US

V. Phone/Fax

Practice location:
  • Phone: 513-885-1090
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code347C00000X
TaxonomyPrivate Vehicle
License Number
License Number StateNULL
# 2
Primary TaxonomyN
Taxonomy Code253Z00000X
TaxonomyIn Home Supportive Care Agency
License Number
License Number StateNULL

VIII. Authorized Official

Name: SHENELL GRAHAM
Title or Position: OWNER
Credential:
Phone: 513-202-6201