MEDICARE: SH OF SOUTHERN OHIO, 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	251E00000X	Home Health Agency

General Provider Information

NPI Number	:	1790286375
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	SH OF SOUTHERN OHIO, LLC

Provider Business Mailing Address
First Line	:	1157 WESTCHESTER WAY
Second Line	:
City	:	CINCINNATI
State	:	OH
Zip	:	45244-5040
Country	:	US
Telephone Number	:
Fax Number	:

Provider Business Practice Location Address
First Line	:	1157 WESTCHESTER WAY
Second Line	:
City	:	CINCINNATI
State	:	OH
Zip	:	45244-5040
Country	:	US
Telephone Number	:	513-325-6779
Fax Number	:

Authorized Official
Title or Position	:	CEO
Name	:	ROSS GOODSON
Credential	:
Telephone Number	:	513-300-2719

Provider Enumeration Date	:	02/28/2018
Last Update Date	:	02/28/2018

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