Healthcare Provider Details

I. General information

NPI: 1689280943
Provider Name (Legal Business Name): SERVUCARE HOME CARE
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 09/21/2020
Last Update Date: 06/14/2022
Certification Date: 06/14/2022
Deactivation Date:
Reactivation Date:

III. Provider practice location address

33 DONALD DR STE 1
FAIRFIELD OH
45014-3022
US

IV. Provider business mailing address

4803 JAVELIN DR
ROCKFORD IL
61108-2301
US

V. Phone/Fax

Practice location:
  • Phone: 513-580-8218
  • Fax:
Mailing address:
  • Phone: 779-537-8837
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code251E00000X
TaxonomyHome Health Agency
License Number
License Number State

VIII. Authorized Official

Name: MRS. KAWONIA NEELY
Title or Position: CEO
Credential:
Phone: 513-580-8218