MEDICARE: GUAVA CARE OF OHIO, INC.

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	:	1841501061
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	GUAVA CARE OF OHIO, INC.

Provider Business Mailing Address
First Line	:	1055 SAINT PAUL PL
Second Line	:
City	:	CINCINNATI
State	:	OH
Zip	:	45202-6042
Country	:	US
Telephone Number	:	513-673-5315
Fax Number	:	513-672-2274

Provider Business Practice Location Address
First Line	:	1055 SAINT PAUL PL
Second Line	:
City	:	CINCINNATI
State	:	OH
Zip	:	45202-6042
Country	:	US
Telephone Number	:	513-673-5315
Fax Number	:	513-672-2274

Authorized Official
Title or Position	:	PRESIDENT
Name	:	NOLAN MARX
Credential	:
Telephone Number	:	513-673-5315

Provider Enumeration Date	:	06/23/2010
Last Update Date	:	06/23/2010

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