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General NPI Number Information
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NPI Number | 1669251567
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Entity Type | Organization
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Legal Business Name | PRODIGIOUS HEALTHCARE
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Dates
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Enumeration Date | 09/28/2023
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Last Update Date | 09/28/2023
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Provider Practice Location Address
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Address Line | 3204 SIENNA DR
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City | CINCINNATI
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State | OH
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Zip | 45251-1025
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Country | US
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Telephone | 513-413-4471
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Fax |
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Provider Business Mailing Address
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Address Line | 3204 SIENNA DR
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City | CINCINNATI
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State | OH
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Zip | 45251-1025
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Country | US
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Telephone | 513-413-4471
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Fax |
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Authorized Official
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Title or Position | DOO
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Name | DANIKKA LATRICE JONES
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Credential | RN
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Telephone | 513-413-4471
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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 |
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License Number State |
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