MEDICARE: OUR FAMILY LEGACY 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	:	1417678855
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	OUR FAMILY LEGACY LLC

Provider Business Mailing Address
First Line	:	11 GARFIELD PL # 1017
Second Line	:
City	:	CINCINNATI
State	:	OH
Zip	:	45202-4301
Country	:	US
Telephone Number	:	513-399-7360
Fax Number	:	513-880-0386

Provider Business Practice Location Address
First Line	:	11 GARFIELD PL # 1017
Second Line	:
City	:	CINCINNATI
State	:	OH
Zip	:	45202-4301
Country	:	US
Telephone Number	:	513-399-7360
Fax Number	:	513-880-0386

Authorized Official
Title or Position	:	CEO
Name	:	JENNIFER COLE
Credential	:
Telephone Number	:	513-885-4267

Provider Enumeration Date	:	09/05/2022
Last Update Date	:	09/05/2022

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