Provider Demographics
NPI:1255877205
Name:SHONITA RILEY
Entity type:Organization
Organization Name:SHONITA RILEY
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:STNA / CAREGIVER
Authorized Official - Prefix:
Authorized Official - First Name:SHONITA
Authorized Official - Middle Name:
Authorized Official - Last Name:RILEY
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:937-830-9142
Mailing Address - Street 1:5511 AUTUMN WOODS DR
Mailing Address - Street 2:APARTMENT 6
Mailing Address - City:TROTWOOD
Mailing Address - State:OH
Mailing Address - Zip Code:45426-4616
Mailing Address - Country:US
Mailing Address - Phone:
Mailing Address - Fax:
Practice Address - Street 1:5511 AUTUMN WOODS DR
Practice Address - Street 2:
Practice Address - City:DAYTON
Practice Address - State:OH
Practice Address - Zip Code:45426-4616
Practice Address - Country:US
Practice Address - Phone:937-830-9142
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2017-01-15
Last Update Date:2017-01-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OH400809440908251E00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes251E00000XAgenciesHome Health