Provider Demographics
NPI:1770617177
Name:QUINTELLA, ALICE
Entity type:Individual
Prefix:MS
First Name:ALICE
Middle Name:
Last Name:QUINTELLA
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 1:9481 PARIS AVE
Mailing Address - Street 2:
Mailing Address - City:LOUISVILLE
Mailing Address - State:OH
Mailing Address - Zip Code:44641-9539
Mailing Address - Country:US
Mailing Address - Phone:330-875-5955
Mailing Address - Fax:
Practice Address - Street 1:9481 PARIS AVE
Practice Address - Street 2:
Practice Address - City:LOUISVILLE
Practice Address - State:OH
Practice Address - Zip Code:44641-9539
Practice Address - Country:US
Practice Address - Phone:330-875-5955
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2007-03-15
Last Update Date:2007-07-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes374U00000XNursing Service Related ProvidersHome Health Aide
Provider Identifiers
StateIdentifier IDID TypeIssuer
OH2143308Medicaid