| NPI | 1205841624 |
|---|---|
| Entity Type | Organization |
| Authorized Contact | SHARON M BULLOCK Independent Lpn 513-709-9344 |
| Organization Subpart ? | No |
| Primary Taxonomy | 164W00000X Licensed Practical Nurse (Licence: OH pn090343) |
| Additional Taxonomies | 251E00000X Home Health (Licence: OH pn090343) |
| 302F00000X Exclusive Provider Organization (Licence: OH pn090343) | |
| 302R00000X Health Maintenance Organization (Licence: OH PN090343) | |
| 305R00000X Preferred Provider Organization (Licence: OH pn090343) | |
| 343900000X Non-emergency Medical Transport (VAN) (Licence: OH BRODI) | |
| 347C00000X Private Vehicle (Licence: OH rp227337) | |
| Enumeration Date | 2006-07-31 |
| Last Update Date | 2020-08-22 |