MEDICARE: MS. PATRICE LORISE WILLIS

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy
1	251E00000X	Home Health Agency
2	385H00000X	Respite Care
3	374U00000X	Home Health Aide

General Provider Information

NPI Number	:	1417725862
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	MS. PATRICE LORISE WILLIS

Provider Business Mailing Address
First Line	:	31850 TUCKER DR
Second Line	:
City	:	NORTH RIDGEVILLE
State	:	OH
Zip	:	44039-7307
Country	:	US
Telephone Number	:	830-765-1141
Fax Number	:

Provider Business Practice Location Address
First Line	:	31850 TUCKER DR
Second Line	:
City	:	NORTH RIDGEVILLE
State	:	OH
Zip	:	44039-7307
Country	:	US
Telephone Number	:	830-765-1141
Fax Number	:

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

Provider Enumeration Date	:	12/14/2023
Last Update Date	:	12/14/2023

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