Provider Demographics
NPI:1740154483
Name:PROVIDENCE FERTILITY CARE, LLC
Entity type:Organization
Organization Name:PROVIDENCE FERTILITY CARE, LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:BUSINESS MANAGER
Authorized Official - Prefix:
Authorized Official - First Name:JACOB
Authorized Official - Middle Name:
Authorized Official - Last Name:RODEHEFFER
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:650-417-1118
Mailing Address - Street 1:2723 POWELL DR
Mailing Address - Street 2:
Mailing Address - City:CINCINNATI
Mailing Address - State:OH
Mailing Address - Zip Code:45211-7209
Mailing Address - Country:US
Mailing Address - Phone:650-417-1118
Mailing Address - Fax:513-323-6825
Practice Address - Street 1:2723 POWELL DR
Practice Address - Street 2:
Practice Address - City:CINCINNATI
Practice Address - State:OH
Practice Address - Zip Code:45211-7209
Practice Address - Country:US
Practice Address - Phone:650-417-1118
Practice Address - Fax:513-323-6825
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2025-10-04
Last Update Date:2025-10-04
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QF0050XAmbulatory Health Care FacilitiesClinic/CenterFamily Planning, Non-Surgical