Provider Demographics
NPI:1568844504
Name:PRIVATE DUTY
Entity Type:Organization
Organization Name:PRIVATE DUTY
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:STNA
Authorized Official - Prefix:
Authorized Official - First Name:SAMONE
Authorized Official - Middle Name:
Authorized Official - Last Name:GLOVERF
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:513-580-3180
Mailing Address - Street 1:56 GAHL TER APT 8
Mailing Address - Street 2:
Mailing Address - City:CINCINNATI
Mailing Address - State:OH
Mailing Address - Zip Code:45215-3685
Mailing Address - Country:US
Mailing Address - Phone:513-787-1224
Mailing Address - Fax:
Practice Address - Street 1:56 GAHL TER APT 8
Practice Address - Street 2:
Practice Address - City:CINCINNATI
Practice Address - State:OH
Practice Address - Zip Code:45215-3685
Practice Address - Country:US
Practice Address - Phone:513-787-1224
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2015-06-26
Last Update Date:2015-06-26
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes251E00000XAgenciesHome Health