Healthcare Provider Details

I. General information

NPI: 1477980399
Provider Name (Legal Business Name): ADMIRA HEALTHCARE SERVICES,LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 10/09/2013
Last Update Date: 10/09/2013
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

4613 CUTLASS DR
ENGLEWOOD OH
45322-2515
US

IV. Provider business mailing address

4613 CUTLASS DR
ENGLEWOOD OH
45322-2515
US

V. Phone/Fax

Practice location:
  • Phone: 937-248-6394
  • Fax:
Mailing address:
  • Phone: 937-248-6394
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code251E00000X
TaxonomyHome Health Agency
License Number
License Number State
# 2
Primary TaxonomyN
Taxonomy Code251J00000X
TaxonomyNursing Care Agency
License Number
License Number State

VIII. Authorized Official

Name: CLIVE FOMENKY
Title or Position: CEO
Credential:
Phone: 937-248-6394