MEDICARE: JEANETTE HOLLIDAY

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy
1	376J00000X	Homemaker
2	385H00000X	Respite Care
3	347C00000X	Private Vehicle
4	3747P1801X	Personal Care Attendant
5	253Z00000X	In Home Supportive Care Agency

General Provider Information

NPI Number	:	1760152698
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	JEANETTE HOLLIDAY

Provider Business Mailing Address
First Line	:	4868 WILLOW SPRINGS DR
Second Line	:
City	:	LIBERTY TWP
State	:	OH
Zip	:	45011-7587
Country	:	US
Telephone Number	:	513-509-1646
Fax Number	:

Provider Business Practice Location Address
First Line	:	4868 WILLOW SPRINGS DR
Second Line	:
City	:	LIBERTY TWP
State	:	OH
Zip	:	45011-7587
Country	:	US
Telephone Number	:	513-509-1646
Fax Number	:

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	09/13/2021
Last Update Date	:	09/13/2021

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Directions to “ JEANETTE HOLLIDAY ” Practice Location

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