Provider Demographics
NPI:1114170610
Name:ALLIED SENIOR CARE LLC
Entity Type:Organization
Organization Name:ALLIED SENIOR CARE LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:
Authorized Official - First Name:HUSAM
Authorized Official - Middle Name:
Authorized Official - Last Name:HAMED
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:859-759-0668
Mailing Address - Street 1:3645 STONECREEK BLVD UNIT E
Mailing Address - Street 2:
Mailing Address - City:CINCINNATI
Mailing Address - State:OH
Mailing Address - Zip Code:45251-1469
Mailing Address - Country:US
Mailing Address - Phone:859-759-0668
Mailing Address - Fax:888-892-8098
Practice Address - Street 1:3645 STONECREEK BLVD UNIT E
Practice Address - Street 2:
Practice Address - City:CINCINNATI
Practice Address - State:OH
Practice Address - Zip Code:45251-1469
Practice Address - Country:US
Practice Address - Phone:513-687-0500
Practice Address - Fax:513-598-1107
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2008-10-28
Last Update Date:2013-11-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OH207Q00000X
KY207Q00000X
363A00000X, 363LF0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily MedicineGroup - Multi-Specialty
No363A00000XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician AssistantGroup - Multi-Specialty
No363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamilyGroup - Multi-Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
KY7100061030Medicaid
OH2879961Medicaid
KY7100086450Medicaid
KY00827Medicare PIN
OH9381081Medicare PIN
DO6254Medicare PIN
OHDQ4753Medicare PIN