Healthcare Provider Details

I. General information

NPI: 1477370401
Provider Name (Legal Business Name): IVAKAY HEALTHCARE SERVICES
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 09/23/2024
Last Update Date: 10/30/2024
Certification Date: 10/30/2024
Deactivation Date:
Reactivation Date:

III. Provider practice location address

8308 DRAYMORE
BLACKLICK OH
43004-8032
US

IV. Provider business mailing address

PO BOX 1640
REYNOLDSBURG OH
43068-6640
US

V. Phone/Fax

Practice location:
  • Phone: 614-698-9893
  • Fax:
Mailing address:
  • Phone: 614-698-9893
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code251C00000X
TaxonomyDevelopmentally Disabled Services Day Training Agency
License Number
License Number State
# 2
Primary TaxonomyN
Taxonomy Code347C00000X
TaxonomyPrivate Vehicle
License Number
License Number State

VIII. Authorized Official

Name: DR. RAWLINGS EBOT ENOW
Title or Position: CEO
Credential: PHARM.D
Phone: 614-853-3836