Healthcare Provider Details

I. General information

NPI: 1891178240
Provider Name (Legal Business Name): EMBRACECARE
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 07/02/2015
Last Update Date: 07/02/2015
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

5707 FOREST ELM LN
COLUMBUS OH
43229-3728
US

IV. Provider business mailing address

5707 FOREST ELM LN
COLUMBUS OH
43229-3728
US

V. Phone/Fax

Practice location:
  • Phone: 614-359-3618
  • Fax:
Mailing address:
  • Phone: 614-359-3618
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code172A00000X
TaxonomyDriver
License NumberSS720863
License Number StateOH
# 2
Primary TaxonomyY
Taxonomy Code253Z00000X
TaxonomyIn Home Supportive Care Agency
License Number
License Number StateOH

VIII. Authorized Official

Name: MR. BERMANE JEANLOUIS
Title or Position: PRESIDENT/CEO
Credential: DODD PROVIDER
Phone: 614-359-3618