Provider Demographics
NPI:1316748833
Name:MCENTIRE, SHERLISA KELLY
Entity type:Individual
Prefix:
First Name:SHERLISA
Middle Name:KELLY
Last Name:MCENTIRE
Suffix:
Gender:
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:4231 HEGNER AVE
Mailing Address - Street 2:
Mailing Address - City:CINCINNATI
Mailing Address - State:OH
Mailing Address - Zip Code:45236-3656
Mailing Address - Country:US
Mailing Address - Phone:513-301-8765
Mailing Address - Fax:
Practice Address - Street 1:4231 HEGNER AVE
Practice Address - Street 2:
Practice Address - City:CINCINNATI
Practice Address - State:OH
Practice Address - Zip Code:45236-3656
Practice Address - Country:US
Practice Address - Phone:513-301-8765
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2025-03-20
Last Update Date:2025-03-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OH320600000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes320600000XResidential Treatment FacilitiesResidential Treatment Facility, Intellectual and/or Developmental Disabilities