MEDICARE: DJM3 HOMECARE AGENCY

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

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	151484409	OTHER	OH	HOME HEALTH NURSE

General Provider Information

NPI Number	:	1710550728
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	DJM3 HOMECARE AGENCY

Provider Business Mailing Address
First Line	:	7504 PERRY ST
Second Line	:
City	:	CINCINNATI
State	:	OH
Zip	:	45231-7500
Country	:	US
Telephone Number	:
Fax Number	:

Provider Business Practice Location Address
First Line	:	1410 SPRINGFIELD PIKE APT 4
Second Line	:
City	:	CINCINNATI
State	:	OH
Zip	:	45215-2130
Country	:	US
Telephone Number	:	513-883-7038
Fax Number	:

Authorized Official
Title or Position	:	OWNER/NURSE
Name	:	CAROLYN NICHOLE MOTLEY
Credential	:
Telephone Number	:	513-883-7038

Provider Enumeration Date	:	07/19/2021
Last Update Date	:	07/19/2021

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Directions to “DJM3 HOMECARE AGENCY ” Practice Location

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