Healthcare Provider Details

I. General information

NPI: 1679404206
Provider Name (Legal Business Name): LILLY MAE SERVICES FOR INDIVIDUALS WITH DEVELOPMENTAL DISABILITIES
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 05/25/2026
Last Update Date: 05/25/2026
Certification Date: 05/24/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

260 NORTHLAND BLVD STE 216
CINCINNATI OH
45246-3651
US

IV. Provider business mailing address

2358 MAGDALENA DR
CINCINNATI OH
45231-2261
US

V. Phone/Fax

Practice location:
  • Phone: 513-227-6573
  • Fax:
Mailing address:
  • Phone: 513-227-6573
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code374U00000X
TaxonomyHome Health Aide
License Number
License Number State
# 2
Primary TaxonomyY
Taxonomy Code376J00000X
TaxonomyHomemaker
License Number
License Number State

VIII. Authorized Official

Name: MR. KENNETH ANDRE BRYANT JR.
Title or Position: CEO, DOO
Credential: DO
Phone: 513-227-6573