MEDICARE: PERSONALIZED HEALTHCARE SERVICES 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		OH

General Provider Information

NPI Number	:	1902178130
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	PERSONALIZED HEALTHCARE SERVICES LLC

Provider Business Mailing Address
First Line	:	4663 EXECUTIVE DR
Second Line	:	STE# 1
City	:	COLUMBUS
State	:	OH
Zip	:	43220-3627
Country	:	US
Telephone Number	:	614-754-1176
Fax Number	:	614-754-1288

Provider Business Practice Location Address
First Line	:	4663 EXECUTIVE DR
Second Line	:	STE# 1
City	:	COLUMBUS
State	:	OH
Zip	:	43220
Country	:	US
Telephone Number	:	614-745-1176
Fax Number	:	614-754-1288

Authorized Official
Title or Position	:	PRESIDENT/CEO
Name	:	MS. KAREN S DAVID
Credential	:	R.N., B.S.C.,
Telephone Number	:	614-754-1176

Provider Enumeration Date	:	02/03/2012
Last Update Date	:	04/27/2015

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