MEDICARE: PARENT PROMISE

Medicare Provider Information

Scope of Practice

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

#	Taxonomy Code	Taxonomy
1	175T00000X	Peer Specialist
2	251B00000X	Case Management Agency
3	251S00000X	Community/Behavioral Health Agency

General Provider Information

NPI Number	:	1447029475
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	PARENT PROMISE

Provider Business Mailing Address
First Line	:	3617 EVERETT AVE
Second Line	:
City	:	CINCINNATI
State	:	OH
Zip	:	45211-5504
Country	:	US
Telephone Number	:	513-816-1546
Fax Number	:

Provider Business Practice Location Address
First Line	:	3646 GLENMORE AVE # 7
Second Line	:
City	:	CHEVIOT
State	:	OH
Zip	:	45211-4730
Country	:	US
Telephone Number	:	513-816-1546
Fax Number	:

Authorized Official
Title or Position	:	FOUNDER
Name	:	CANDACE STALLWORTH
Credential	:
Telephone Number	:	513-816-1546

Provider Enumeration Date	:	01/02/2024
Last Update Date	:	01/02/2024

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Directions to “PARENT PROMISE ” Practice Location

Language	Start Address	Practice Location

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