1508111410 NPI number — THE RESIDENT HOME CORPORATION

Table of Contents

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1508111410 NPI number — THE RESIDENT HOME CORPORATION

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
THE RESIDENT HOME CORPORATION
Provider Last Name:
Provider First Name:
Provider Middle Name:
Provider Name Prefix Text:
Provider Name Suffix Text:
Provider Credential Text:
Provider Gender Code:

Provider's Other Name Information

Provider Other Organization Name:
Provider Other Organization Name Type Code:
Provider Other Last Name:
Provider Other First Name:
Provider Other Middle Name:
Provider Other Name Prefix Text:
Provider Other Name Suffix Text:
Provider Other Credential Text:
Provider Other Last Name Type Code:

NPI Number Information

NPI Number:
1508111410
Entity Type Code:
Organization
Replacement NPI:
Last Update Date:
05/30/2018
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
3030 W FORK RD
Provider Second Line Business Mailing Address:
Provider Business Mailing Address City Name:
CINCINNATI
Provider Business Mailing Address State Name:
OH
Provider Business Mailing Address Postal Code:
45211-1944
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
513-389-7500
Provider Business Mailing Address Fax Number:
513-389-7508

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
3030 W FORK RD
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
CINCINNATI
Provider Business Practice Location Address State Name:
OH
Provider Business Practice Location Address Postal Code:
45211
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
513-389-7500
Provider Business Practice Location Address Fax Number:
513-389-7508
Provider Enumeration Date:
07/17/2012

Additional Information

Authorized Official

Authorized Official Last Name:
STEFFEY
Authorized Official First Name:
JAMES
Authorized Official Middle Name:
Authorized Official Title or Position:
CHIEF EXECUTIVE OFFICER
Authorized Official Telephone Number:
513-389-7500

Provider Taxonomy Codes

  • Taxonomy code: 251S00000X ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

Other Provider's Identifiers (legacy, non-NPI)

  • Identifier: 3100218 , issued by the state of ( OH ) . This identifiers is of the category "MEDICAID".




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