MEDICARE: INDIA EFFA FORD LCDC II

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	101YA0400X	Addiction (Substance Use Disorder) Counselor	LCDCII.162014	OH

General Provider Information

NPI Number	:	1457921611
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	INDIA EFFA FORD LCDC II

Provider Business Mailing Address
First Line	:	3559 READING RD APT 317
Second Line	:
City	:	CINCINNATI
State	:	OH
Zip	:	45229-2677
Country	:	US
Telephone Number	:
Fax Number	:

Provider Business Practice Location Address
First Line	:	1 TRIANGLE PARK DR
Second Line	:
City	:	CINCINNATI
State	:	OH
Zip	:	45246-3423
Country	:	US
Telephone Number	:	855-246-2095
Fax Number	:

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

Provider Enumeration Date	:	06/30/2021
Last Update Date	:	08/29/2024

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