Executive Heritage'S Assisted Living, Inc

Primary specialty

In Home Supportive Care AgencyTaxonomy code 253Z00000X

Legal business name

EXECUTIVE HERITAGE'S ASSISTED LIVING, INC

Practice address

4050 Executive Park Dr Ste 240
Cincinnati, OH 45241-2094

Phone

(513) 518-4631

NPI assigned

Oct 14, 2020

Organization subpart

No

Registry information is reported by the provider to CMS and is not verified. About this source

Authorized official

Name

Amanuel Daniachew, MD

Title

Owner

Phone

(619) 403-6906

Specialties & licenses 2

Addresses

Other identifiers 1

Locations

The complete NPPES record for this NPI in the NPI Registry API format.

{
    "created_epoch": "1602633600000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1602633600000",
    "number": "1437757143",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "4050 EXECUTIVE PARK DR STE 240",
            "city": "CINCINNATI",
            "state": "OH",
            "postal_code": "452412094",
            "telephone_number": "513-518-4631"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "4050 EXECUTIVE PARK DR STE 240",
            "city": "CINCINNATI",
            "state": "OH",
            "postal_code": "452412094",
            "telephone_number": "513-518-4631"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "EXECUTIVE HERITAGE'S ASSISTED LIVING, INC",
        "organizational_subpart": "NO",
        "enumeration_date": "2020-10-14",
        "last_updated": "2020-10-14",
        "certification_date": "2020-10-14",
        "status": "A",
        "authorized_official_last_name": "DANIACHEW",
        "authorized_official_first_name": "AMANUEL",
        "authorized_official_title_or_position": "OWNER",
        "authorized_official_telephone_number": "619-403-6906",
        "authorized_official_credential": "MD"
    },
    "taxonomies": [
        {
            "code": "251S00000X",
            "taxonomy_group": "",
            "desc": "Community/Behavioral Health",
            "state": null,
            "license": null,
            "primary": false
        },
        {
            "code": "253Z00000X",
            "taxonomy_group": "",
            "desc": "In Home Supportive Care",
            "state": null,
            "license": null,
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "0229867",
            "state": "OH"
        }
    ],
    "endpoints": [],
    "other_names": []
}

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• In Home Supportive Care Agency in Cincinnati, OH
• Providers in Cincinnati, OH by specialty
• In Home Supportive Care Agency in Ohio

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Oct 14, 2020; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
• National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.