MEDICARE: MS. ANITA LEE GAINES

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	:	1346826518
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	MS. ANITA LEE GAINES

Provider Business Mailing Address
First Line	:	8715 MOONLIGHT DR
Second Line	:
City	:	CINCINNATI
State	:	OH
Zip	:	45231-4115
Country	:	US
Telephone Number	:	513-462-0549
Fax Number	:

Provider Business Practice Location Address
First Line	:	8715 MOONLIGHT DR
Second Line	:
City	:	CINCINNATI
State	:	OH
Zip	:	45231-4115
Country	:	US
Telephone Number	:	513-729-1599
Fax Number	:

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

Provider Enumeration Date	:	03/19/2021
Last Update Date	:	03/19/2021

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