=====================================================
General NPI Number Information
=====================================================
NPI Number | 1538851621
-----------------------------------------------------
Entity Type | Organization
-----------------------------------------------------
Legal Business Name | RUSSCARE HOME HEALTH AID
-----------------------------------------------------
=====================================================
Dates
=====================================================
Enumeration Date | 05/25/2023
-----------------------------------------------------
Last Update Date | 01/31/2024
-----------------------------------------------------
=====================================================
Provider Practice Location Address
=====================================================
Address Line | 7504 TIKI DR
-----------------------------------------------------
City | CINCINNATI
-----------------------------------------------------
State | OH
-----------------------------------------------------
Zip | 45243-1751
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 513-908-5484
-----------------------------------------------------
Fax |
-----------------------------------------------------
=====================================================
Provider Business Mailing Address
=====================================================
Address Line | 7504 TIKI DR
-----------------------------------------------------
City | CINCINNATI
-----------------------------------------------------
State | OH
-----------------------------------------------------
Zip | 45243-1751
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 513-908-5484
-----------------------------------------------------
Fax |
-----------------------------------------------------
=====================================================
Authorized Official
=====================================================
Title or Position | OWNER
-----------------------------------------------------
Name | TIFFANY MARIE HALE
-----------------------------------------------------
Credential | RN
-----------------------------------------------------
Telephone | 513-908-5484
-----------------------------------------------------
=====================================================
Scope of Practice (Provider's specialty)
=====================================================
Taxonomy #1
-----------------------------------------------------
Taxonomy Code | 374U00000X
-----------------------------------------------------
Taxonomy Name | Home Health Aide
-----------------------------------------------------
License Number |
-----------------------------------------------------
License Number State |
-----------------------------------------------------