MEDICARE: TAKE CARE HEALTH OHIO, INC.

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	363LF0000X	Family Nurse Practitioner

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program

General Provider Information

NPI Number	:	1457549677
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	TAKE CARE HEALTH OHIO, INC.

Provider Business Mailing Address
First Line	:	1901 E VOORHEES ST
Second Line	:	MS# 640
City	:	DANVILLE
State	:	IL
Zip	:	61834-4509
Country	:	US
Telephone Number	:	855-925-4733
Fax Number	:	217-709-2345

Provider Business Practice Location Address
First Line	:	9775 COLERAIN AVE
Second Line	:
City	:	CINCINNATI
State	:	OH
Zip	:	45251-1442
Country	:	US
Telephone Number	:	855-925-4733
Fax Number	:	217-709-2345

Authorized Official
Title or Position	:	ASSISTANT SECRETARY
Name	:	DEBORAH HEGG
Credential	:
Telephone Number	:	217-709-2469

Provider Enumeration Date	:	10/12/2007
Last Update Date	:	11/23/2016

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