Healthcare Provider Details

I. General information

NPI: 1245631894
Provider Name (Legal Business Name): LISA RUCKER
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 09/12/2014
Last Update Date: 05/22/2025
Certification Date: 05/22/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

3583 ALASKA AVE APT D9
CINCINNATI OH
45229-2546
US

IV. Provider business mailing address

3583 ALASKA AVE APT D9
CINCINNATI OH
45229-2546
US

V. Phone/Fax

Practice location:
  • Phone: 513-401-5006
  • Fax:
Mailing address:
  • Phone: 513-401-5006
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code372600000X
TaxonomyAdult Companion
License Number373366980494
License Number StateOH
# 2
Primary TaxonomyN
Taxonomy Code3747A0650X
TaxonomyAttendant Care Provider
License Number373366980494
License Number StateOH
# 3
Primary TaxonomyN
Taxonomy Code3747P1801X
TaxonomyPersonal Care Attendant
License Number373366980494
License Number StateOH
# 4
Primary TaxonomyN
Taxonomy Code374U00000X
TaxonomyHome Health Aide
License Number373366980494
License Number StateOH
# 5
Primary TaxonomyN
Taxonomy Code376J00000X
TaxonomyHomemaker
License Number373366980494
License Number StateOH
# 6
Primary TaxonomyN
Taxonomy Code376K00000X
TaxonomyNurse's Aide
License Number373366980494
License Number StateOH
# 7
Primary TaxonomyY
Taxonomy Code171M00000X
TaxonomyCase Manager/Care Coordinator
License Number
License Number State

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: