MEDICARE: SACRED LIVING MED-CARE 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	:	1366055238
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	SACRED LIVING MED-CARE LLC

Provider Business Mailing Address
First Line	:	856 RIDGEWAY AVE APT 1
Second Line	:
City	:	CINCINNATI
State	:	OH
Zip	:	45229-3379
Country	:	US
Telephone Number	:	513-365-7742
Fax Number	:

Provider Business Practice Location Address
First Line	:	856 RIDGEWAY AVE APT 1
Second Line	:
City	:	CINCINNATI
State	:	OH
Zip	:	45229-3379
Country	:	US
Telephone Number	:	513-365-7742
Fax Number	:

Authorized Official
Title or Position	:	MANAGING MEMBER/OWNER
Name	:	NIEISHA WARD
Credential	:
Telephone Number	:	513-365-7742

Provider Enumeration Date	:	08/28/2020
Last Update Date	:	09/06/2023

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Directions to “SACRED LIVING MED-CARE LLC ” Practice Location

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