=====================================================
General NPI Number Information
=====================================================
NPI Number | 1568187953
-----------------------------------------------------
Entity Type | Organization
-----------------------------------------------------
Legal Business Name | ALEXA WAY LLC
-----------------------------------------------------
=====================================================
Dates
=====================================================
Enumeration Date | 10/07/2022
-----------------------------------------------------
Last Update Date | 10/07/2022
-----------------------------------------------------
=====================================================
Provider Practice Location Address
=====================================================
Address Line | 1230 ANTHONY LN
-----------------------------------------------------
City | MASON
-----------------------------------------------------
State | OH
-----------------------------------------------------
Zip | 45040-1139
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 513-502-0425
-----------------------------------------------------
Fax | 513-729-6552
-----------------------------------------------------
=====================================================
Provider Business Mailing Address
=====================================================
Address Line | 7183 SCARLET OAK CT
-----------------------------------------------------
City | MASON
-----------------------------------------------------
State | OH
-----------------------------------------------------
Zip | 45040-7304
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 513-502-0425
-----------------------------------------------------
Fax | 513-729-6552
-----------------------------------------------------
=====================================================
Authorized Official
=====================================================
Title or Position | DOO - DIRECTOR OF OPERATIONS
-----------------------------------------------------
Name | MR. PETER CHARLES BARNETT
-----------------------------------------------------
Credential |
-----------------------------------------------------
Telephone | 513-502-0425
-----------------------------------------------------
=====================================================
Scope of Practice (Provider's specialty)
=====================================================
Taxonomy #1
-----------------------------------------------------
Taxonomy Code | 385H00000X
-----------------------------------------------------
Taxonomy Name | Respite Care
-----------------------------------------------------
License Number |
-----------------------------------------------------
License Number State |
-----------------------------------------------------
Taxonomy #2
-----------------------------------------------------
Taxonomy Code | 251E00000X
-----------------------------------------------------
Taxonomy Name | Home Health Agency
-----------------------------------------------------
License Number |
-----------------------------------------------------
License Number State |
-----------------------------------------------------