Provider Demographics
NPI:1366632556
Name:RICH, ALICE JEAN (LPN)
Entity Type:Individual
Prefix:MS
First Name:ALICE
Middle Name:JEAN
Last Name:RICH
Suffix:
Gender:F
Credentials:LPN
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:8502 CONSTITUTION DRIVE
Mailing Address - Street 2:
Mailing Address - City:CINCINNATI
Mailing Address - State:OH
Mailing Address - Zip Code:45215
Mailing Address - Country:US
Mailing Address - Phone:513-233-7786
Mailing Address - Fax:
Practice Address - Street 1:3610 WEST 8TH STREET
Practice Address - Street 2:HOMECARE SYMONE HUCKABY
Practice Address - City:CINCINNATI
Practice Address - State:OH
Practice Address - Zip Code:45205
Practice Address - Country:US
Practice Address - Phone:513-251-4825
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2007-07-25
Last Update Date:2007-07-25
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OHPN077897164W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes164W00000XNursing Service ProvidersLicensed Practical Nurse
Provider Identifiers
StateIdentifier IDID TypeIssuer
2802508Medicare UPIN