MEDICARE: CENTRIX HEALTH SYSTEMS LLC

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

General Provider Information

NPI Number	:	1255990305
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	CENTRIX HEALTH SYSTEMS LLC

Provider Business Mailing Address
First Line	:	PO BOX 563
Second Line	:
City	:	SPRINGBORO
State	:	OH
Zip	:	45066-0563
Country	:	US
Telephone Number	:	937-503-1962
Fax Number	:

Provider Business Practice Location Address
First Line	:	488 SAINT JAMES PL
Second Line	:
City	:	SPRINGBORO
State	:	OH
Zip	:	45066-9746
Country	:	US
Telephone Number	:	937-503-1962
Fax Number	:

Authorized Official
Title or Position	:	OWNER
Name	:	JAY ANTHONY VITALI
Credential	:
Telephone Number	:	937-503-1962

Provider Enumeration Date	:	06/12/2019
Last Update Date	:	06/12/2019

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Directions to “CENTRIX HEALTH SYSTEMS LLC ” Practice Location

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