MEDICARE: PRIVATE DUTY

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

General Provider Information

NPI Number	:	1568844504
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	PRIVATE DUTY

Provider Business Mailing Address
First Line	:	56 GAHL TER APT 8
Second Line	:
City	:	CINCINNATI
State	:	OH
Zip	:	45215-3685
Country	:	US
Telephone Number	:	513-787-1224
Fax Number	:

Provider Business Practice Location Address
First Line	:	56 GAHL TER APT 8
Second Line	:
City	:	CINCINNATI
State	:	OH
Zip	:	45215-3685
Country	:	US
Telephone Number	:	513-787-1224
Fax Number	:

Authorized Official
Title or Position	:	STNA
Name	:	SAMONE GLOVERF
Credential	:
Telephone Number	:	513-580-3180

Provider Enumeration Date	:	06/26/2015
Last Update Date	:	06/26/2015

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Directions to “PRIVATE DUTY ” Practice Location

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