Healthcare Provider Details

I. General information

NPI: 1225632359
Provider Name (Legal Business Name): JEANINE CAUDILL
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 11/30/2020
Last Update Date: 11/30/2020
Certification Date: 11/30/2020
Deactivation Date:
Reactivation Date:

III. Provider practice location address

3881 MEYERFELD AVE
CINCINNATI OH
45211-4810
US

IV. Provider business mailing address

3881 MEYERFELD AVE
CINCINNATI OH
45211-4810
US

V. Phone/Fax

Practice location:
  • Phone: 513-485-6840
  • Fax:
Mailing address:
  • Phone: 513-485-6840
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code374U00000X
TaxonomyHome Health Aide
License Number
License Number State

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: