Provider Demographics
NPI:1942806518
Name:HALE, JUAN
Entity Type:Individual
Prefix:
First Name:JUAN
Middle Name:
Last Name:HALE
Suffix:
Gender:M
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:11711 PRINCETON PIKE STE 341-327
Mailing Address - Street 2:
Mailing Address - City:CINCINNATI
Mailing Address - State:OH
Mailing Address - Zip Code:45246-2534
Mailing Address - Country:US
Mailing Address - Phone:513-291-9499
Mailing Address - Fax:
Practice Address - Street 1:1172 WAYCROSS RD APT B211
Practice Address - Street 2:
Practice Address - City:CINCINNATI
Practice Address - State:OH
Practice Address - Zip Code:45240-3047
Practice Address - Country:US
Practice Address - Phone:605-940-0427
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2020-12-09
Last Update Date:2020-12-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes374U00000XNursing Service Related ProvidersHome Health Aide