MEDICARE: KEITH HENRY

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	3747P1801X	Personal Care Attendant
2	376J00000X	Homemaker

General Provider Information

NPI Number	:	1770398265
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	KEITH HENRY

Provider Business Mailing Address
First Line	:	7515 CASTLETON PL
Second Line	:
City	:	CINCINNATI
State	:	OH
Zip	:	45237-2633
Country	:	US
Telephone Number	:	513-708-0584
Fax Number	:

Provider Business Practice Location Address
First Line	:	7515 CASTLETON PL
Second Line	:
City	:	CINCINNATI
State	:	OH
Zip	:	45237-2633
Country	:	US
Telephone Number	:	513-708-0584
Fax Number	:

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

Provider Enumeration Date	:	02/11/2025
Last Update Date	:	02/11/2025

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