MEDICARE: SALISA FLAGG

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	RN315930	OH

General Provider Information

NPI Number	:	1184001026
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	SALISA FLAGG

Provider Business Mailing Address
First Line	:	4302 SULLIVAN AVE
Second Line	:
City	:	CINCINNATI
State	:	OH
Zip	:	45217-1747
Country	:	US
Telephone Number	:	513-379-2191
Fax Number	:

Provider Business Practice Location Address
First Line	:	4302 SULLIVAN AVE
Second Line	:
City	:	CINCINNATI
State	:	OH
Zip	:	45217-1747
Country	:	US
Telephone Number	:	513-379-2191
Fax Number	:

Authorized Official
Title or Position	:	RN
Name	:	MRS. SALISA FLAGG
Credential	:
Telephone Number	:	513-379-2191

Provider Enumeration Date	:	04/29/2015
Last Update Date	:	04/29/2015

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