Healthcare Provider Details

I. General information

NPI: 1629724794
Provider Name (Legal Business Name): RAENELL CAUDILL
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 02/26/2022
Last Update Date: 02/26/2022
Certification Date: 02/26/2022
Deactivation Date:
Reactivation Date:

III. Provider practice location address

861 BEECHER ST
CINCINNATI OH
45206-1537
US

IV. Provider business mailing address

2912 WHEATFIELD DR
CINCINNATI OH
45251-1632
US

V. Phone/Fax

Practice location:
  • Phone: 513-291-8586
  • Fax:
Mailing address:
  • Phone: 513-291-8584
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

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

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: