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General NPI Number Information
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NPI Number | 1679604862
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Entity Type | Organization
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Legal Business Name | WESTSIDE RESIDENTAIL
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Dates
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Enumeration Date | 03/08/2007
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Last Update Date | 08/22/2020
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Provider Practice Location Address
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Address Line | 3047 GLENWAY AVE APT 3
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City | CINCINNATI
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State | OH
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Zip | 45204-1646
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Country | US
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Telephone | 513-766-8484
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Fax | 513-681-5832
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Provider Business Mailing Address
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Address Line | 6908 GOLFWAY DR
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City | CINCINNATI
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State | OH
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Zip | 45239-5631
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Country | US
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Telephone | 513-766-8484
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Fax | 513-681-5832
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Authorized Official
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Title or Position | CEO PRESIDENT
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Name | MISS SHAWNTAY CORISHA OLIVER
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Credential | CEO,EMT,STNA,CNA
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Telephone | 513-766-8484
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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 | OH
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