MEDICARE: RISAN LIFE HOME CARE 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	374U00000X	Home Health Aide

General Provider Information

NPI Number	:	1598602765
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	RISAN LIFE HOME CARE LLC

Provider Business Mailing Address
First Line	:	2071 MISTYHILL DR
Second Line	:
City	:	CINCINNATI
State	:	OH
Zip	:	45240-3351
Country	:	US
Telephone Number	:
Fax Number	:

Provider Business Practice Location Address
First Line	:	2071 MISTYHILL DR
Second Line	:
City	:	CINCINNATI
State	:	OH
Zip	:	45240-3351
Country	:	US
Telephone Number	:	980-301-2919
Fax Number	:

Authorized Official
Title or Position	:	OWNER
Name	:	TYARA TUCKER
Credential	:
Telephone Number	:	980-301-2919

Provider Enumeration Date	:	05/04/2026
Last Update Date	:	05/04/2026

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