Provider Demographics
NPI:1881459469
Name:RILEY, LABARON MARQUISE JR
Entity type:Individual
Prefix:
First Name:LABARON
Middle Name:MARQUISE
Last Name:RILEY
Suffix:JR
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 1:977 COVEDALE AVE
Mailing Address - Street 2:
Mailing Address - City:CINCINNATI
Mailing Address - State:OH
Mailing Address - Zip Code:45238-4309
Mailing Address - Country:US
Mailing Address - Phone:513-693-2324
Mailing Address - Fax:
Practice Address - Street 1:977 COVEDALE AVE
Practice Address - Street 2:
Practice Address - City:CINCINNATI
Practice Address - State:OH
Practice Address - Zip Code:45238-4309
Practice Address - Country:US
Practice Address - Phone:513-693-2324
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2024-02-14
Last Update Date:2024-02-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes251E00000XAgenciesHome Health