Provider Demographics
NPI:1144051129
Name:GIFTEDSOULS513 LIMITED LIABILITY COMPANY
Entity type:Organization
Organization Name:GIFTEDSOULS513 LIMITED LIABILITY COMPANY
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:
Authorized Official - First Name:MIRANDA
Authorized Official - Middle Name:MAE
Authorized Official - Last Name:MUSE
Authorized Official - Suffix:
Authorized Official - Credentials:CERTIFIED NURSE AIDE
Authorized Official - Phone:513-375-8984
Mailing Address - Street 1:3190 MCHENRY AVE
Mailing Address - Street 2:
Mailing Address - City:CINCINNATI
Mailing Address - State:OH
Mailing Address - Zip Code:45211-7343
Mailing Address - Country:US
Mailing Address - Phone:513-375-8984
Mailing Address - Fax:
Practice Address - Street 1:3190 MCHENRY AVE
Practice Address - Street 2:
Practice Address - City:CINCINNATI
Practice Address - State:OH
Practice Address - Zip Code:45211-7343
Practice Address - Country:US
Practice Address - Phone:513-375-8984
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2024-08-12
Last Update Date:2024-08-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes251E00000XAgenciesHome Health