1295964005 NPI number — BRAYS GENENSIS ELDER CARE

Table of content: (NPI 1295964005)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1295964005 NPI number — BRAYS GENENSIS ELDER CARE

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
BRAYS GENENSIS ELDER CARE
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:
1295964005
Entity Type Code:
Organization
Replacement NPI:
Last Update Date:
07/21/2022
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
3251 HIGHLAND AVE.
Provider Second Line Business Mailing Address:
SUITE 100
Provider Business Mailing Address City Name:
CINCINNATI
Provider Business Mailing Address State Name:
OH
Provider Business Mailing Address Postal Code:
45213
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
513-522-1659
Provider Business Mailing Address Fax Number:
513-531-1400

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
3251 HIGHLAND AVE.
Provider Second Line Business Practice Location Address:
SUITE 100
Provider Business Practice Location Address City Name:
CINCINNATI
Provider Business Practice Location Address State Name:
OH
Provider Business Practice Location Address Postal Code:
45213
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
513-522-1659
Provider Business Practice Location Address Fax Number:
513-531-1400
Provider Enumeration Date:
07/14/2009

Additional Information

			
		

Authorized Official

Authorized Official Last Name:
BRAY
Authorized Official First Name:
DOROTHY
Authorized Official Middle Name:
AMELIA
Authorized Official Title or Position:
OWNER
Authorized Official Telephone Number:
513-522-1659

Provider Taxonomy Codes

  • Taxonomy code: 163W00000X , with the licence number:  TAXI.D.# , registered in the state of OH ; information, associated with the NPI states the following Primary Taxonomy Switch: "N" .
  • Taxonomy code: 164W00000X , with the licence number: TAXI.D.# , registered in the state of OH ; information, associated with the NPI states the following Primary Taxonomy Switch: "N" .
  • Taxonomy code: 372500000X , with the licence number: TAXI.D.# , registered in the state of OH ; information, associated with the NPI states the following Primary Taxonomy Switch: "N" .
  • Taxonomy code: 372600000X , with the licence number: TAXI.D.# , registered in the state of OH ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .
  • Taxonomy code: 374U00000X , with the licence number: TAXI.D.# , registered in the state of OH ; information, associated with the NPI states the following Primary Taxonomy Switch: "N" .
  • Taxonomy code: 376J00000X , with the licence number: TAXI.D.# , registered in the state of OH ; information, associated with the NPI states the following Primary Taxonomy Switch: "N" .

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