Provider Demographics
NPI:1669083697
Name:EXAPTIONAL SENIOR CARE
Entity type:Organization
Organization Name:EXAPTIONAL SENIOR CARE
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:LPN
Authorized Official - Prefix:
Authorized Official - First Name:JAVONTE
Authorized Official - Middle Name:LISA
Authorized Official - Last Name:AVERY
Authorized Official - Suffix:
Authorized Official - Credentials:LPN
Authorized Official - Phone:513-501-0211
Mailing Address - Street 1:7373 BROOK CREST RD
Mailing Address - Street 2:342
Mailing Address - City:CINCINNATI
Mailing Address - State:OH
Mailing Address - Zip Code:45237
Mailing Address - Country:US
Mailing Address - Phone:513-832-3024
Mailing Address - Fax:513-832-3023
Practice Address - Street 1:7373 BROOK CREST RD
Practice Address - Street 2:342
Practice Address - City:CINCINNATI
Practice Address - State:OH
Practice Address - Zip Code:45237
Practice Address - Country:US
Practice Address - Phone:513-832-3024
Practice Address - Fax:513-832-3023
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2020-08-13
Last Update Date:2020-08-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes251E00000XAgenciesHome Health
No251J00000XAgenciesNursing Care
Provider Identifiers
StateIdentifier IDID TypeIssuer
OH0373806Medicaid