MEDICARE: ELANA DENEAN GRAY

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	:	1275253197
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	ELANA DENEAN GRAY

Provider Business Mailing Address
First Line	:	5311 GRAFTON AVE
Second Line	:
City	:	CINCINNATI
State	:	OH
Zip	:	45237-5811
Country	:	US
Telephone Number	:	513-391-4106
Fax Number	:

Provider Business Practice Location Address
First Line	:	5311 GRAFTON AVE
Second Line	:
City	:	CINCINNATI
State	:	OH
Zip	:	45237-5811
Country	:	US
Telephone Number	:	513-391-4106
Fax Number	:

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

Provider Enumeration Date	:	08/31/2022
Last Update Date	:	08/31/2022

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Directions to “ ELANA DENEAN GRAY ” Practice Location

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