MEDICARE: MRS. KLORISSA DJ MATTHEW

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	374U00000X	Home Health Aide

General Provider Information

NPI Number	:	1174301824
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	MRS. KLORISSA DJ MATTHEW

Provider Business Mailing Address
First Line	:	1929 ARTHUR PL
Second Line	:
City	:	CINCINNATI
State	:	OH
Zip	:	45225-1901
Country	:	US
Telephone Number	:	513-255-8236
Fax Number	:

Provider Business Practice Location Address
First Line	:	1929 ARTHUR PL
Second Line	:
City	:	CINCINNATI
State	:	OH
Zip	:	45225-1901
Country	:	US
Telephone Number	:	513-255-8236
Fax Number	:

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

Provider Enumeration Date	:	09/14/2023
Last Update Date	:	09/14/2023

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