Healthcare Provider Details

I. General information

NPI: 1548034747
Provider Name (Legal Business Name): CARLA MESHEA FREEMAN
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 11/08/2023
Last Update Date: 11/08/2023
Certification Date: 11/08/2023
Deactivation Date:
Reactivation Date:

III. Provider practice location address

9985 DUNRAVEN DR
CINCINNATI OH
45251-1654
US

IV. Provider business mailing address

9985 DUNRAVEN DR
CINCINNATI OH
45251-1654
US

V. Phone/Fax

Practice location:
  • Phone: 513-284-6803
  • Fax:
Mailing address:
  • Phone: 513-284-6803
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code347C00000X
TaxonomyPrivate Vehicle
License NumberRZ818576
License Number StateOH
# 2
Primary TaxonomyN
Taxonomy Code3747P1801X
TaxonomyPersonal Care Attendant
License Number
License Number StateNULL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: