MEDICARE: ARIEL OLINA ELMORE

Medicare Provider Information

Scope of Practice

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

#	Taxonomy Code	Taxonomy
1	343900000X	Non-emergency Medical Transport (VAN)
2	385H00000X	Respite Care
3	385HR2060X	Child Intellectual and/or Developmental Disabilities Respite Care
4	374U00000X	Home Health Aide

General Provider Information

NPI Number	:	1184398315
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	ARIEL OLINA ELMORE

Provider Business Mailing Address
First Line	:	5980 MARINE PKWY APT F115
Second Line	:
City	:	MENTOR ON THE LAKE
State	:	OH
Zip	:	44060-2895
Country	:	US
Telephone Number	:	440-728-7854
Fax Number	:

Provider Business Practice Location Address
First Line	:	5980 MARINE PKWY APT F115
Second Line	:
City	:	MENTOR ON THE LAKE
State	:	OH
Zip	:	44060-2895
Country	:	US
Telephone Number	:	440-728-7854
Fax Number	:

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

Provider Enumeration Date	:	08/02/2021
Last Update Date	:	08/02/2021

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