Healthcare Provider Details

I. General information

NPI: 1962500124
Provider Name (Legal Business Name): DLCA LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 09/20/2006
Last Update Date: 08/22/2020
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

71 VISTA RIDGE DR
SOUTH LEBANON OH
45065-8755
US

IV. Provider business mailing address

71 VISTA RIDGE DR
SOUTH LEBANON OH
45065-8755
US

V. Phone/Fax

Practice location:
  • Phone: 513-292-6564
  • Fax:
Mailing address:
  • Phone: 513-292-6564
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207R00000X
TaxonomyInternal Medicine Physician
License Number
License Number StateOH

VIII. Authorized Official

Name: DR. KENRICK SYLVESTER RICHARDSON
Title or Position: OWNER-PRESIDENT
Credential: M.D.
Phone: 513-292-6564