Self Employee

Primary specialty

Adult Care Home FacilityTaxonomy code 311ZA0620X

License

PN134284IV Issued in OH

Legal business name

SELF EMPLOYEE

Practice address

3053 Nicholas Rd
Dayton, OH 45417-4322

Phone

(937) 516-7887

NPI assigned

Nov 12, 2009

Organization subpart

No

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

Authorized official

Name

Kania Monique McCleskey

Title

LPN

Phone

(937) 516-7887

Specialties & licenses 1

Addresses

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

{
    "created_epoch": "1257984000000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1362528000000",
    "number": "1669709606",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "3053 NICHOLAS RD",
            "city": "DAYTON",
            "state": "OH",
            "postal_code": "454174322",
            "telephone_number": "937-516-7887"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "3053 NICHOLAS RD",
            "city": "DAYTON",
            "state": "OH",
            "postal_code": "454174322",
            "telephone_number": "937-516-7887"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "SELF EMPLOYEE",
        "organizational_subpart": "NO",
        "enumeration_date": "2009-11-12",
        "last_updated": "2013-03-06",
        "status": "A",
        "authorized_official_last_name": "MCCLESKEY",
        "authorized_official_first_name": "KANIA",
        "authorized_official_middle_name": "MONIQUE",
        "authorized_official_title_or_position": "LPN",
        "authorized_official_telephone_number": "937-516-7887"
    },
    "taxonomies": [
        {
            "code": "311ZA0620X",
            "taxonomy_group": "",
            "desc": "Custodial Care Facility, Adult Care Home",
            "state": "OH",
            "license": "PN134284IV",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

• Kiran Polisetty Sekhar, MD
• Select Physical Therapy of Ohio Limited Partnership
• Selective Home Health Supplies
• Selective Nursing LLC
• Selective Nursing, LLC
• Self Matters LLC
• Jennifer R Sell, QMHS/CMS
• Alexis Sellers, CDCA
• Melissa Sellers, LPN
• Tracy M Sellers, QMHS/CMS

• Adult Care Home Facility in Dayton, OH
• Providers in Dayton, OH by specialty
• Adult Care Home Facility in Ohio

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Mar 6, 2013; 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.