Healthcare Provider Details

I. General information

NPI: 1790251411
Provider Name (Legal Business Name): MR. LOUIS EDWARD GEHRING III
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 10/19/2018
Last Update Date: 10/19/2018
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

11459 GRAVENHURST DR
CINCINNATI OH
45231-1234
US

IV. Provider business mailing address

11459 GRAVENHURST DR
CINCINNATI OH
45231-1234
US

V. Phone/Fax

Practice location:
  • Phone: 513-885-7286
  • Fax:
Mailing address:
  • Phone: 513-885-7286
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code374U00000X
TaxonomyHome Health Aide
License Number2225890
License Number StateOH

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: