Healthcare Provider Details

I. General information

NPI: 1083742761
Provider Name (Legal Business Name): MAPLE LEAF HOME HEALTH CARE
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 03/02/2007
Last Update Date: 01/09/2009
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

935 S JAMES RD
COLUMBUS OH
43227-1069
US

IV. Provider business mailing address

935 S JAMES RD
COLUMBUS OH
43227-1069
US

V. Phone/Fax

Practice location:
  • Phone: 614-586-1553
  • Fax: 614-586-1556
Mailing address:
  • Phone: 614-586-1553
  • Fax: 614-586-1556

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code163WC1500X
TaxonomyCommunity Health Registered Nurse
License Number
License Number State

VIII. Authorized Official

Name: MR. JOSEPH ANTHONY JERKINS
Title or Position: OWNER
Credential: RPH
Phone: 614-586-1553