Healthcare Provider Details

I. General information

NPI: 1952940835
Provider Name (Legal Business Name): NABHCO, LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 12/25/2019
Last Update Date: 06/05/2024
Certification Date: 06/05/2024
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2686 CROSSROADS PLAZA DR.
COLUMBUS OH
43219-3442
US

IV. Provider business mailing address

1391 W 5TH AVE # 241
COLUMBUS OH
43212-2902
US

V. Phone/Fax

Practice location:
  • Phone: 877-318-0934
  • Fax: 888-831-0965
Mailing address:
  • Phone: 877-318-0934
  • Fax: 888-831-0965

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code207Q00000X
TaxonomyFamily Medicine Physician
License Number
License Number State
# 2
Primary TaxonomyY
Taxonomy Code207QA0401X
TaxonomyAddiction Medicine (Family Medicine) Physician
License Number
License Number State
# 3
Primary TaxonomyN
Taxonomy Code2084A0401X
TaxonomyAddiction Medicine (Psychiatry & Neurology) Physician
License Number
License Number State
# 4
Primary TaxonomyN
Taxonomy Code2084P0800X
TaxonomyPsychiatry Physician
License Number
License Number State
# 5
Primary TaxonomyN
Taxonomy Code2084P0802X
TaxonomyAddiction Psychiatry Physician
License Number
License Number State
# 6
Primary TaxonomyN
Taxonomy Code363LF0000X
TaxonomyFamily Nurse Practitioner
License Number
License Number State

VIII. Authorized Official

Name: DR. LATONYA JANETT CARROLL
Title or Position: OWNER
Credential: DNP, APRN.CNP
Phone: 877-318-0934