Healthcare Provider Details

I. General information

NPI: 1477458586
Provider Name (Legal Business Name): MIRADO CROW
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 10/09/2026
Last Update Date: 10/09/2026
Certification Date: 10/09/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

111 LEATHER LEAF LN
LEBANON OH
45036-7711
US

IV. Provider business mailing address

PO BOX 11
SHANDON OH
45063-0011
US

V. Phone/Fax

Practice location:
  • Phone: 513-513-2369
  • Fax:
Mailing address:
  • Phone: 513-236-9850
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

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

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: