=====================================================
General NPI Number Information
=====================================================
NPI Number | 1093430050
-----------------------------------------------------
Entity Type | Organization
-----------------------------------------------------
Legal Business Name | DORCAS BRIDGE HEALTH CARE LLC
-----------------------------------------------------
=====================================================
Dates
=====================================================
Enumeration Date | 10/11/2022
-----------------------------------------------------
Last Update Date | 10/11/2022
-----------------------------------------------------
=====================================================
Provider Practice Location Address
=====================================================
Address Line | 260 NORTHLAND BLVD STE 113A
-----------------------------------------------------
City | CINCINNATI
-----------------------------------------------------
State | OH
-----------------------------------------------------
Zip | 45246-4921
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 513-772-0111
-----------------------------------------------------
Fax | 513-772-5111
-----------------------------------------------------
=====================================================
Provider Business Mailing Address
=====================================================
Address Line | 260 NORTHLAND BLVD STE 113A
-----------------------------------------------------
City | CINCINNATI
-----------------------------------------------------
State | OH
-----------------------------------------------------
Zip | 45246-4921
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 513-772-0111
-----------------------------------------------------
Fax |
-----------------------------------------------------
=====================================================
Authorized Official
=====================================================
Title or Position | CEO
-----------------------------------------------------
Name | TAYEWO SERIKI
-----------------------------------------------------
Credential |
-----------------------------------------------------
Telephone | 513-501-3220
-----------------------------------------------------
=====================================================
Scope of Practice (Provider's specialty)
=====================================================
Taxonomy #1
-----------------------------------------------------
Taxonomy Code | 251E00000X
-----------------------------------------------------
Taxonomy Name | Home Health Agency
-----------------------------------------------------
License Number |
-----------------------------------------------------
License Number State |
-----------------------------------------------------