Provider Demographics
NPI:1801012661
Name:REDMOND, GERMAINE LATISHA (HOME HEALTH AIDE)
Entity Type:Individual
Prefix:MRS
First Name:GERMAINE
Middle Name:LATISHA
Last Name:REDMOND
Suffix:
Gender:F
Credentials:HOME HEALTH AIDE
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2643 GREENBRIER DR
Mailing Address - Street 2:
Mailing Address - City:DAYTON
Mailing Address - State:OH
Mailing Address - Zip Code:45406-1336
Mailing Address - Country:US
Mailing Address - Phone:937-278-3979
Mailing Address - Fax:937-278-3979
Practice Address - Street 1:2643 GREENBRIER DR
Practice Address - Street 2:
Practice Address - City:DAYTON
Practice Address - State:OH
Practice Address - Zip Code:45406-1336
Practice Address - Country:US
Practice Address - Phone:937-278-3979
Practice Address - Fax:937-278-3979
Is Sole Proprietor?:Yes
Enumeration Date:2007-04-18
Last Update Date:2007-07-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OH2111913374U00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes374U00000XNursing Service Related ProvidersHome Health Aide
Provider Identifiers
StateIdentifier IDID TypeIssuer
OH2111913Medicaid