Healthcare Provider Details

I. General information

NPI: 1841739323
Provider Name (Legal Business Name): MOTHERS & SONS CAREGIVING
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 02/17/2017
Last Update Date: 02/17/2017
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

680 N BROADWAY ST
LEBANON OH
45036-1724
US

IV. Provider business mailing address

680 N BROADWAY ST
LEBANON OH
45036-1724
US

V. Phone/Fax

Practice location:
  • Phone: 513-292-3425
  • Fax:
Mailing address:
  • Phone: 513-292-3425
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code251C00000X
TaxonomyDevelopmentally Disabled Services Day Training Agency
License Number
License Number State

VIII. Authorized Official

Name: MRS. CALLENA GAYLE BENTON
Title or Position: CEO
Credential:
Phone: 513-292-3425