MEDICARE: TRI - COUNTY LIVING ASSISTANCE SERVICES, LLC

Medicare Provider Information

Scope of Practice

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

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	251E00000X	Home Health Agency

General Provider Information

NPI Number	:	1124217161
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	TRI - COUNTY LIVING ASSISTANCE SERVICES, LLC

Provider Business Mailing Address
First Line	:	7419 KINGSGATE WAY
Second Line	:
City	:	WEST CHESTER
State	:	OH
Zip	:	45069-2486
Country	:	US
Telephone Number	:	513-777-4860
Fax Number	:	513-777-4865

Provider Business Practice Location Address
First Line	:	7419 KINGSGATE WAY
Second Line	:
City	:	WEST CHESTER
State	:	OH
Zip	:	45069-6517
Country	:	US
Telephone Number	:	513-777-4860
Fax Number	:	513-777-4865

Authorized Official
Title or Position	:	PRESIDENT
Name	:	MR. GLENN CAPRI SR.
Credential	:	CSA
Telephone Number	:	513-777-4860

Provider Enumeration Date	:	10/16/2007
Last Update Date	:	03/04/2021

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