MEDICARE: FIRST STEP HOME, INC.

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	324500000X	Substance Abuse Rehabilitation Facility	7190	OH

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	2996	OTHER	OH	ODADAS UPI

General Provider Information

NPI Number	:	1154377612
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	FIRST STEP HOME, INC.

Provider Business Mailing Address
First Line	:	2203 FULTON AVE
Second Line	:
City	:	CINCINNATI
State	:	OH
Zip	:	45206-2504
Country	:	US
Telephone Number	:	513-961-4663
Fax Number	:	513-961-4681

Provider Business Practice Location Address
First Line	:	2203 FULTON AVE
Second Line	:
City	:	CINCINNATI
State	:	OH
Zip	:	45206-2504
Country	:	US
Telephone Number	:	513-961-4663
Fax Number	:	513-961-4681

Authorized Official
Title or Position	:	PRESIDENT
Name	:	MS. MARGO SPENCE
Credential	:
Telephone Number	:	513-961-4663

Provider Enumeration Date	:	05/26/2006
Last Update Date	:	07/25/2008

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