MEDICARE: SISTERS INQORPORATED 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	2391432	OH

General Provider Information

NPI Number	:	1477931467
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	SISTERS INQORPORATED LLC

Provider Business Mailing Address
First Line	:	1521 NOE BIXBY RD
Second Line	:
City	:	COLUMBUS
State	:	OH
Zip	:	43232-1580
Country	:	US
Telephone Number	:	614-657-5995
Fax Number	:	614-626-3632

Provider Business Practice Location Address
First Line	:	5990 E LIVINGSTON AVE
Second Line	:
City	:	COLUMBUS
State	:	OH
Zip	:	43232-2927
Country	:	US
Telephone Number	:	614-657-5995
Fax Number	:	614-626-3632

Authorized Official
Title or Position	:	CEO/OWNER
Name	:	KALICE SMITH-MOCK
Credential	:	RN
Telephone Number	:	614-657-5995

Provider Enumeration Date	:	05/11/2015
Last Update Date	:	05/11/2015

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