Healthcare Provider Details

I. General information

NPI: 1053863613
Provider Name (Legal Business Name): NORTHWEST ADULT SERVICES LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 10/31/2016
Last Update Date: 08/14/2026
Certification Date: 08/14/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

6435 DIXIE HWY
FAIRFIELD OH
45014-5421
US

IV. Provider business mailing address

4400 BRECKENRIDGE LN STE 300
LOUISVILLE KY
40218-4129
US

V. Phone/Fax

Practice location:
  • Phone: 513-493-2544
  • Fax: 800-864-3906
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code253Z00000X
TaxonomyIn Home Supportive Care Agency
License Number
License Number State
# 2
Primary TaxonomyN
Taxonomy Code261QA0600X
TaxonomyAdult Day Care Clinic/Center
License Number
License Number State
# 3
Primary TaxonomyY
Taxonomy Code385H00000X
TaxonomyRespite Care
License Number3925642
License Number StateOH

VIII. Authorized Official

Name: TODD COKE
Title or Position: CFO
Credential:
Phone: 502-210-0723