Healthcare Provider Details

I. General information

NPI: 1861907834
Provider Name (Legal Business Name): CARLA SUE DAASCH
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 12/12/2017
Last Update Date: 12/12/2017
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

476 RIDDLE RD
CINCINNATI OH
45220-2411
US

IV. Provider business mailing address

8085 THISTLEWOOD DR
WEST CHESTER OH
45069-2010
US

V. Phone/Fax

Practice location:
  • Phone: 513-281-8001
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code376G00000X
TaxonomyNursing Home Administrator
License Number5757-3
License Number StateOH

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: