Provider Demographics
NPI:1760114615
Name:CHAMBERS, KESHIA
Entity Type:Individual
Prefix:
First Name:KESHIA
Middle Name:
Last Name:CHAMBERS
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:9594 LEDGE ACRES DR
Mailing Address - Street 2:
Mailing Address - City:MACEDONIA
Mailing Address - State:OH
Mailing Address - Zip Code:44056-1072
Mailing Address - Country:US
Mailing Address - Phone:216-338-4338
Mailing Address - Fax:
Practice Address - Street 1:9594 LEDGE ACRES DR
Practice Address - Street 2:
Practice Address - City:MACEDONIA
Practice Address - State:OH
Practice Address - Zip Code:44056-1072
Practice Address - Country:US
Practice Address - Phone:216-338-4338
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2022-06-29
Last Update Date:2022-06-29
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes253Z00000XAgenciesIn Home Supportive Care
No171WH0202XOther Service ProvidersContractorHome ModificationsGroup - Multi-Specialty
No172A00000XOther Service ProvidersDriver
No251E00000XAgenciesHome Health
No372500000XNursing Service Related ProvidersChore Provider
No372600000XNursing Service Related ProvidersAdult Companion
No385H00000XRespite Care FacilityRespite Care
Provider Identifiers
StateIdentifier IDID TypeIssuer
OH0474650Medicaid
OH7719322OtherOHIO DEPARTMENT OF DEVELOPMENTAL DISABILITIES