Non-Agency Provider

Primary specialty

In Home Supportive Care AgencyTaxonomy code 253Z00000X

License

400960020809 Issued in OH

Legal business name

NON-AGENCY PROVIDER

Practice address

225 Edna Ave
Fairborn, OH 45324-2354

Phone

(937) 878-6886

NPI assigned

Jul 29, 2014

Organization subpart

No

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

Authorized official

Name

Ms. Cynthia S Quinn

Title

Personal Care Aide

Phone

(937) 878-6886

Specialties & licenses 1

Addresses

Other identifiers 2

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

{
    "created_epoch": "1406592000000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1406592000000",
    "number": "1790193142",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "225 EDNA AVE",
            "city": "FAIRBORN",
            "state": "OH",
            "postal_code": "453242354",
            "telephone_number": "937-878-6886"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "225 EDNA AVE",
            "city": "FAIRBORN",
            "state": "OH",
            "postal_code": "453242354",
            "telephone_number": "937-878-6886"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "NON-AGENCY PROVIDER",
        "organizational_subpart": "NO",
        "enumeration_date": "2014-07-29",
        "last_updated": "2014-07-29",
        "status": "A",
        "authorized_official_last_name": "QUINN",
        "authorized_official_first_name": "CYNTHIA",
        "authorized_official_middle_name": "S",
        "authorized_official_title_or_position": "PERSONAL CARE AIDE",
        "authorized_official_telephone_number": "937-878-6886",
        "authorized_official_name_prefix": "Ms."
    },
    "taxonomies": [
        {
            "code": "253Z00000X",
            "taxonomy_group": "",
            "desc": "In Home Supportive Care",
            "state": "OH",
            "license": "400960020809",
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "MEDICAID WAIVER PROGRAM",
            "identifier": "0071052",
            "state": "OH"
        },
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "0071052",
            "state": "OH"
        }
    ],
    "endpoints": [],
    "other_names": []
}

• Matondo Lucia Ngemba
• Hilda M Ngoh, PMHMP-BC
• Gloria Nadine Nichols, B.S., LCDC III
• Witney Nichols
• Belinda Sue Niece, APRN-CNP
• Christian Nordenstrom
• Joshua Nordstrom, LSW
• Kamerin Norris, CDCA
• Lisa Norris
• Elizabeth Justine Nourse, MD

• In Home Supportive Care Agency in Fairborn, OH
• Providers in Fairborn, 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 Jul 29, 2014; 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.