MEDICARE: YOUR WELCOME HOUSE

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	251B00000X	Case Management Agency	141305	OH
2	291U00000X	Clinical Medical Laboratory	141305	OH
3	347C00000X	Private Vehicle	141305	OH
4	324500000X	Substance Abuse Rehabilitation Facility	141305	OH

General Provider Information

NPI Number	:	1154865400
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	YOUR WELCOME HOUSE

Provider Business Mailing Address
First Line	:	11332 LINCOLNSHIRE DR
Second Line	:
City	:	CINCINNATI
State	:	OH
Zip	:	45240
Country	:	US
Telephone Number	:	513-623-1343
Fax Number	:

Provider Business Practice Location Address
First Line	:	11332 LINCOLNSHIRE DR
Second Line	:
City	:	CINCINNATI
State	:	OH
Zip	:	45240-2339
Country	:	US
Telephone Number	:	513-623-1343
Fax Number	:

Authorized Official
Title or Position	:	LCDCII DIRECTOR
Name	:	MS. VENITA MCCLAIR
Credential	:	LCDCII
Telephone Number	:	513-623-1343

Provider Enumeration Date	:	12/06/2016
Last Update Date	:	12/30/2016

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Directions to “YOUR WELCOME HOUSE ” Practice Location

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