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General NPI Number Information
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NPI Number | 1255877205
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Entity Type | Organization
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Legal Business Name | SHONITA RILEY
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Dates
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Enumeration Date | 01/15/2017
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Last Update Date | 01/15/2017
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Provider Practice Location Address
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Address Line | 5511 AUTUMN WOODS DR
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City | DAYTON
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State | OH
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Zip | 45426-4616
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Country | US
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Telephone | 937-830-9142
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Fax |
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Provider Business Mailing Address
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Address Line | 5511 AUTUMN WOODS DR APARTMENT 6
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City | TROTWOOD
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State | OH
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Zip | 45426-4616
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Country | US
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Telephone |
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Fax |
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Authorized Official
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Title or Position | STNA / CAREGIVER
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Name | SHONITA RILEY
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Credential |
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Telephone | 937-830-9142
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 251E00000X
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Taxonomy Name | Home Health Agency
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License Number | 400809440908
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License Number State | OH
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