Provider Demographics
NPI:1447048533
Name:MCENTIRE, TARA RENEE
Entity type:Individual
Prefix:
First Name:TARA
Middle Name:RENEE
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 1:2196 LINCOLN AVE
Mailing Address - Street 2:
Mailing Address - City:CINCINNATI
Mailing Address - State:OH
Mailing Address - Zip Code:45224-1828
Mailing Address - Country:US
Mailing Address - Phone:513-903-2554
Mailing Address - Fax:513-903-2554
Practice Address - Street 1:2196 LINCOLN AVE
Practice Address - Street 2:
Practice Address - City:CINCINNATI
Practice Address - State:OH
Practice Address - Zip Code:45224-1828
Practice Address - Country:US
Practice Address - Phone:513-903-2554
Practice Address - Fax:513-903-2554
Is Sole Proprietor?:Yes
Enumeration Date:2025-04-28
Last Update Date:2025-04-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes320600000XResidential Treatment FacilitiesResidential Treatment Facility, Intellectual and/or Developmental Disabilities