Provider Demographics
NPI:1477215614
Name:VIRTUOUS SUPPORTED LIVING
Entity Type:Organization
Organization Name:VIRTUOUS SUPPORTED LIVING
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:CEO
Authorized Official - Prefix:
Authorized Official - First Name:JOHNMICA
Authorized Official - Middle Name:
Authorized Official - Last Name:MASON
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:513-967-5023
Mailing Address - Street 1:4909 HAWAIIAN TER
Mailing Address - Street 2:
Mailing Address - City:CINCINNATI
Mailing Address - State:OH
Mailing Address - Zip Code:45223-1159
Mailing Address - Country:US
Mailing Address - Phone:513-967-5023
Mailing Address - Fax:
Practice Address - Street 1:4909 HAWAIIAN TER
Practice Address - Street 2:
Practice Address - City:CINCINNATI
Practice Address - State:OH
Practice Address - Zip Code:45223-1159
Practice Address - Country:US
Practice Address - Phone:513-967-5023
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2021-10-05
Last Update Date:2021-10-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes251E00000XAgenciesHome Health