Provider Demographics
NPI:1053741108
Name:CINCINNATI SUPPORT SERVICES
Entity type:Organization
Organization Name:CINCINNATI SUPPORT SERVICES
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT/CEO
Authorized Official - Prefix:MISS
Authorized Official - First Name:JANAE
Authorized Official - Middle Name:N
Authorized Official - Last Name:WALKER
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:513-253-9612
Mailing Address - Street 1:1821 SUMMIT RD
Mailing Address - Street 2:STE 216
Mailing Address - City:CINCINNATI
Mailing Address - State:OH
Mailing Address - Zip Code:45237-2822
Mailing Address - Country:US
Mailing Address - Phone:513-834-5298
Mailing Address - Fax:513-297-6021
Practice Address - Street 1:1821 SUMMIT RD
Practice Address - Street 2:STE 216
Practice Address - City:CINCINNATI
Practice Address - State:OH
Practice Address - Zip Code:45237-2822
Practice Address - Country:US
Practice Address - Phone:513-834-5298
Practice Address - Fax:513-297-6021
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2013-11-26
Last Update Date:2013-11-26
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OH0087137251E00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes251E00000XAgenciesHome Health
Provider Identifiers
StateIdentifier IDID TypeIssuer
OH0087137Medicaid