Provider Demographics
NPI:1487785622
Name:CRASE, REBECCA ANN (HOME HEALTHCARE AIDE)
Entity type:Individual
Prefix:
First Name:REBECCA
Middle Name:ANN
Last Name:CRASE
Suffix:
Gender:F
Credentials:HOME HEALTHCARE AIDE
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:126 S. C ST
Mailing Address - Street 2:APT. B
Mailing Address - City:HAMILTON
Mailing Address - State:OH
Mailing Address - Zip Code:45013-3320
Mailing Address - Country:US
Mailing Address - Phone:513-264-8890
Mailing Address - Fax:
Practice Address - Street 1:126 S C ST
Practice Address - Street 2:APT. B
Practice Address - City:HAMILTON
Practice Address - State:OH
Practice Address - Zip Code:45013-3320
Practice Address - Country:US
Practice Address - Phone:513-264-8890
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2007-03-08
Last Update Date:2007-07-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OH2667270374U00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes374U00000XNursing Service Related ProvidersHome Health Aide
Provider Identifiers
StateIdentifier IDID TypeIssuer
OH2667270Medicaid