Provider Demographics
NPI:1386886026
Name:CHERISH LIFE INCORPORATED
Entity type:Organization
Organization Name:CHERISH LIFE INCORPORATED
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:EXECUTIVE DIRECTOR
Authorized Official - Prefix:MRS
Authorized Official - First Name:CHERISH
Authorized Official - Middle Name:L
Authorized Official - Last Name:BOWMAN
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:513-523-6424
Mailing Address - Street 1:6411 OXFORD MILFORD RD
Mailing Address - Street 2:
Mailing Address - City:OXFORD
Mailing Address - State:OH
Mailing Address - Zip Code:45056-8896
Mailing Address - Country:US
Mailing Address - Phone:513-523-6424
Mailing Address - Fax:513-523-6424
Practice Address - Street 1:6411 OXFORD MILFORD RD
Practice Address - Street 2:
Practice Address - City:OXFORD
Practice Address - State:OH
Practice Address - Zip Code:45056-8896
Practice Address - Country:US
Practice Address - Phone:513-523-6424
Practice Address - Fax:513-523-6424
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2009-03-26
Last Update Date:2009-03-26
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OH0902027251C00000X, 253Z00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes253Z00000XAgenciesIn Home Supportive Care
No251C00000XAgenciesDay Training, Developmentally Disabled Services
Provider Identifiers
StateIdentifier IDID TypeIssuer
OH0902027OtherOHIO DEPARTMENT OF MENTAL RETARDATION AND DEVELOPMENTAL DISABILITIES CONTRACT #
OH877258Medicaid