Healthcare Provider Details

I. General information

NPI: 1598138364
Provider Name (Legal Business Name): ELVIS MBAH
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 11/02/2015
Last Update Date: 11/02/2015
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

3265 ROCKER DR APT 4
CINCINNATI OH
45239-4154
US

IV. Provider business mailing address

3265 ROCKER DR APT 4
CINCINNATI OH
45239-4154
US

V. Phone/Fax

Practice location:
  • Phone: 513-693-3593
  • Fax:
Mailing address:
  • Phone: 513-693-3593
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code311ZA0620X
TaxonomyAdult Care Home Facility
License Number
License Number StateOH

VIII. Authorized Official

Name: MR. ELVIS N MBAH
Title or Position: HOMECARE
Credential: STNA
Phone: 513-693-3593