MEDICARE: ELVIS MBAH

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	311ZA0620X	Adult Care Home Facility		OH

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	:	1598138364
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	ELVIS MBAH

Provider Business Mailing Address
First Line	:	3265 ROCKER DR APT 4
Second Line	:
City	:	CINCINNATI
State	:	OH
Zip	:	45239-4154
Country	:	US
Telephone Number	:	513-693-3593
Fax Number	:

Provider Business Practice Location Address
First Line	:	3265 ROCKER DR APT 4
Second Line	:
City	:	CINCINNATI
State	:	OH
Zip	:	45239-4154
Country	:	US
Telephone Number	:	513-693-3593
Fax Number	:

Authorized Official
Title or Position	:	HOMECARE
Name	:	MR. ELVIS N MBAH
Credential	:	STNA
Telephone Number	:	513-693-3593

Provider Enumeration Date	:	11/02/2015
Last Update Date	:	11/02/2015

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