Provider Demographics
NPI:1952024705
Name:GERALDS, LATISHA RENEE
Entity Type:Individual
Prefix:
First Name:LATISHA
Middle Name:RENEE
Last Name:GERALDS
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 1:2441 WALDEN GLEN CIR
Mailing Address - Street 2:
Mailing Address - City:CINCINNATI
Mailing Address - State:OH
Mailing Address - Zip Code:45231-1403
Mailing Address - Country:US
Mailing Address - Phone:513-903-0391
Mailing Address - Fax:
Practice Address - Street 1:2441 WALDEN GLEN CIR
Practice Address - Street 2:
Practice Address - City:CINCINNATI
Practice Address - State:OH
Practice Address - Zip Code:45231-1403
Practice Address - Country:US
Practice Address - Phone:513-903-0391
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2022-09-26
Last Update Date:2022-09-26
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OH402232011219174200000X, 372500000X, 372600000X, 3747A0650X, 3747P1801X, 376J00000X, 376K00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes376K00000XNursing Service Related ProvidersNurse's Aide
No174200000XOther Service ProvidersMeals
No372500000XNursing Service Related ProvidersChore Provider
No372600000XNursing Service Related ProvidersAdult Companion
No3747A0650XNursing Service Related ProvidersTechnicianAttendant Care Provider
No3747P1801XNursing Service Related ProvidersTechnicianPersonal Care Attendant
No376J00000XNursing Service Related ProvidersHomemaker