MEDICARE: MS. CAMILLE PATTON PCA

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number State
1	3747P1801X	Personal Care Attendant	OH
2	372600000X	Adult Companion	OH
3	374U00000X	Home Health Aide	OH

General Provider Information

NPI Number	:	1053159160
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	MS. CAMILLE PATTON PCA

Provider Business Mailing Address
First Line	:	3998 E 54TH ST APT 2
Second Line	:
City	:	NEWBURGH HEIGHTS
State	:	OH
Zip	:	44105-4851
Country	:	US
Telephone Number	:	216-647-8579
Fax Number	:

Provider Business Practice Location Address
First Line	:	3998 E 54TH ST APT 2
Second Line	:
City	:	NEWBURGH HEIGHTS
State	:	OH
Zip	:	44105-4851
Country	:	US
Telephone Number	:	216-647-8579
Fax Number	:

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	07/15/2024
Last Update Date	:	07/16/2024

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