Provider Demographics
NPI:1619356243
Name:EDNA TWEEDY
Entity Type:Organization
Organization Name:EDNA TWEEDY
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:STNA
Authorized Official - Prefix:
Authorized Official - First Name:EDNA
Authorized Official - Middle Name:VALEANE
Authorized Official - Last Name:TWEEDY
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:513-546-8866
Mailing Address - Street 1:3637 WABASH AVE
Mailing Address - Street 2:
Mailing Address - City:CINCINNATI
Mailing Address - State:OH
Mailing Address - Zip Code:45207-1223
Mailing Address - Country:US
Mailing Address - Phone:513-546-8866
Mailing Address - Fax:
Practice Address - Street 1:3637 WABASH AVE
Practice Address - Street 2:
Practice Address - City:CINCINNATI
Practice Address - State:OH
Practice Address - Zip Code:45207-1223
Practice Address - Country:US
Practice Address - Phone:513-546-8866
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2015-05-28
Last Update Date:2015-05-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OH310004560991251E00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes251E00000XAgenciesHome Health
Provider Identifiers
StateIdentifier IDID TypeIssuer
OH2239590Medicaid