Healthcare Provider Details

I. General information

NPI: 1821950155
Provider Name (Legal Business Name): BONNIE L WILLIS QMHS
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 11/25/2025
Last Update Date: 06/05/2026
Certification Date: 06/05/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

4968 GLENWAY AVE
CINCINNATI OH
45238-3902
US

IV. Provider business mailing address

2600 VICTORY PKWY
CINCINNATI OH
45206-1395
US

V. Phone/Fax

Practice location:
  • Phone: 513-751-7747
  • Fax:
Mailing address:
  • Phone: 513-751-7747
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code374U00000X
TaxonomyHome Health Aide
License Number
License Number StateOH
# 2
Primary TaxonomyN
Taxonomy Code172V00000X
TaxonomyCommunity Health Worker
License NumberCHW.001833
License Number StateOH
# 3
Primary TaxonomyY
Taxonomy Code171M00000X
TaxonomyCase Manager/Care Coordinator
License Number
License Number StateOH

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: