Healthcare Provider Details

I. General information

NPI: 1356060636
Provider Name (Legal Business Name): MAIDS OF HEAVEN
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 08/22/2022
Last Update Date: 08/23/2022
Certification Date: 08/23/2022
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2379 SAWBURY BLVD
COLUMBUS OH
43235-6520
US

IV. Provider business mailing address

2379 SAWBURY BLVD
COLUMBUS OH
43235-6520
US

V. Phone/Fax

Practice location:
  • Phone: 330-244-7264
  • Fax:
Mailing address:
  • Phone: 330-244-7264
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code224P00000X
TaxonomyProsthetist
License Number
License Number StateNULL
# 2
Primary TaxonomyN
Taxonomy Code343900000X
TaxonomyNon-emergency Medical Transport (VAN)
License Number
License Number StateNULL
# 3
Primary TaxonomyY
Taxonomy Code372500000X
TaxonomyChore Provider
License Number
License Number StateNULL
# 4
Primary TaxonomyN
Taxonomy Code174200000X
TaxonomyMeals Provider
License Number
License Number StateNULL

VIII. Authorized Official

Name: BERNIECE JACKSON-GLENN
Title or Position: OWNER
Credential:
Phone: 330-244-7264