MEDICARE: A&A WISDOM HEALTH CARE LLC

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	251E00000X	Home Health Agency

General Provider Information

NPI Number	:	1205715638
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	A&A WISDOM HEALTH CARE LLC

Provider Business Mailing Address
First Line	:	1533 DE GREVE PL
Second Line	:
City	:	COLUMBUS
State	:	OH
Zip	:	43219-1484
Country	:	US
Telephone Number	:
Fax Number	:

Provider Business Practice Location Address
First Line	:	1533 DE GREVE PL
Second Line	:
City	:	COLUMBUS
State	:	OH
Zip	:	43219-1484
Country	:	US
Telephone Number	:	614-722-5887
Fax Number	:

Authorized Official
Title or Position	:	OWNER
Name	:	ALINE EBAMU FOZONG
Credential	:
Telephone Number	:	614-722-5877

Provider Enumeration Date	:	08/29/2025
Last Update Date	:	08/29/2025

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