MEDICARE: UMBRELLA SUPPORTIVE LIVING 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	253Z00000X	In Home Supportive Care Agency

General Provider Information

NPI Number	:	1972291581
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	UMBRELLA SUPPORTIVE LIVING LLC

Provider Business Mailing Address
First Line	:	5 TRIANGLE PARK DR STE 501
Second Line	:
City	:	CINCINNATI
State	:	OH
Zip	:	45246-3402
Country	:	US
Telephone Number	:	888-295-3954
Fax Number	:	513-672-9589

Provider Business Practice Location Address
First Line	:	5 TRIANGLE PARK DR STE 501
Second Line	:
City	:	CINCINNATI
State	:	OH
Zip	:	45246-3402
Country	:	US
Telephone Number	:	513-237-5764
Fax Number	:	513-672-9589

Authorized Official
Title or Position	:	CEO
Name	:	DAVID W GRAY
Credential	:
Telephone Number	:	888-295-3954

Provider Enumeration Date	:	05/01/2023
Last Update Date	:	05/01/2023

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