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General NPI Number Information
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NPI Number | 1750066460
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Entity Type | Organization
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Legal Business Name | MIDWEST COMMUNITY SUPPORT LLC
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Dates
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Enumeration Date | 06/20/2023
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Last Update Date | 06/20/2023
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Provider Practice Location Address
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Address Line | 3516 HARRISON AVE
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City | CINCINNATI
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State | OH
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Zip | 45211-5595
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Country | US
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Telephone | 513-557-8020
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Fax |
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Provider Business Mailing Address
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Address Line | 6812 TARAWA DR
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City | CINCINNATI
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State | OH
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Zip | 45224-1100
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Country | US
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Telephone | 513-557-8020
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Fax |
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Authorized Official
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Title or Position | DOO
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Name | MS. SIRA SOUMARE
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Credential |
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Telephone | 513-557-8020
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 261QA0600X
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Taxonomy Name | Adult Day Care Clinic/Center
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License Number |
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License Number State |
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