Healthcare Provider Details

I. General information

NPI: 1457956922
Provider Name (Legal Business Name): OHIO VALLEY ADULT DAY SERVICES, LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 12/02/2020
Last Update Date: 12/02/2020
Certification Date: 12/02/2020
Deactivation Date:
Reactivation Date:

III. Provider practice location address

411 APPLE ST
MOUNT ORAB OH
45154-7524
US

IV. Provider business mailing address

411 APPLE ST
MOUNT ORAB OH
45154-7524
US

V. Phone/Fax

Practice location:
  • Phone: 513-582-1392
  • Fax: 937-356-3966
Mailing address:
  • Phone: 513-582-1392
  • Fax: 937-356-3966

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code251C00000X
TaxonomyDevelopmentally Disabled Services Day Training Agency
License Number
License Number State
# 2
Primary TaxonomyN
Taxonomy Code251E00000X
TaxonomyHome Health Agency
License Number
License Number State
# 3
Primary TaxonomyN
Taxonomy Code253Z00000X
TaxonomyIn Home Supportive Care Agency
License Number
License Number State
# 4
Primary TaxonomyN
Taxonomy Code261QA0600X
TaxonomyAdult Day Care Clinic/Center
License Number
License Number State
# 5
Primary TaxonomyN
Taxonomy Code320900000X
TaxonomyIntellectual and/or Developmental Disabilities Community Based Residential Treatment Facility
License Number
License Number State
# 6
Primary TaxonomyN
Taxonomy Code385HR2060X
TaxonomyChild Intellectual and/or Developmental Disabilities Respite Care
License Number
License Number State

VIII. Authorized Official

Name: LISA M HENSLEY BOGGS
Title or Position: OWNER
Credential: MBA
Phone: 513-582-1392