Healthcare Provider Details

I. General information

NPI: 1366706749
Provider Name (Legal Business Name): ADS HEALTH LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 06/29/2012
Last Update Date: 11/10/2016
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

4153 WESTRIDGE DR
MASON OH
45040-4703
US

IV. Provider business mailing address

PO BOX 639081
CINCINNATI OH
45263-9081
US

V. Phone/Fax

Practice location:
  • Phone: 513-482-1529
  • Fax:
Mailing address:
  • Phone:
  • Fax: 513-474-9805

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code314000000X
TaxonomySkilled Nursing Facility
License Number35083638
License Number StateOH

VII. Legacy identifiers

For crosswalk purposes, the following legacy (non-NPI) identifiers are available for this provider:

# 1
Identifier35083638
Identifier TypeOTHER
Identifier StateOH
Identifier IssuerLICENSE
# 2
Identifier2444304
Identifier TypeMEDICAID
Identifier StateOH
Identifier Issuer
# 3
Identifier64074297
Identifier TypeMEDICAID
Identifier StateKY
Identifier Issuer

VIII. Authorized Official

Name: DR. NAVEENA NELSON
Title or Position: PRESIDENT/OWNER
Credential: MD
Phone: 513-482-1529