Healthcare Provider Details

I. General information

NPI: 1285443192
Provider Name (Legal Business Name): BERENGIE AMOH ABAH BA
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 01/06/2025
Last Update Date: 01/06/2025
Certification Date: 01/05/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

3687 ELMORE CT E
COLUMBUS OH
43224-2868
US

IV. Provider business mailing address

3687 ELMORE CT E
COLUMBUS OH
43224-2868
US

V. Phone/Fax

Practice location:
  • Phone: 443-410-8102
  • Fax:
Mailing address:
  • Phone: 443-410-8102
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code251C00000X
TaxonomyDevelopmentally Disabled Services Day Training Agency
License Number602751890124
License Number StateOH
# 2
Primary TaxonomyN
Taxonomy Code251G00000X
TaxonomyCommunity Based Hospice Care Agency
License Number602751890124
License Number StateOH
# 3
Primary TaxonomyN
Taxonomy Code251J00000X
TaxonomyNursing Care Agency
License Number602751890124
License Number StateOH
# 4
Primary TaxonomyY
Taxonomy Code3104A0630X
TaxonomyAssisted Living Facility (Behavioral Disturbances)
License Number602751890124
License Number StateOH
# 5
Primary TaxonomyN
Taxonomy Code374U00000X
TaxonomyHome Health Aide
License Number602751890124
License Number StateOH
# 6
Primary TaxonomyN
Taxonomy Code376K00000X
TaxonomyNurse's Aide
License Number602751890124
License Number StateOH
# 7
Primary TaxonomyN
Taxonomy Code208VP0000X
TaxonomyPain Medicine Physician
License Number602751890124
License Number StateOH
# 8
Primary TaxonomyN
Taxonomy Code2080H0002X
TaxonomyPediatric Hospice and Palliative Medicine Physician
License Number602751890124
License Number StateOH
# 9
Primary TaxonomyN
Taxonomy Code405300000X
TaxonomyPrevention Professional
License Number602751890124
License Number StateOH
# 10
Primary TaxonomyN
Taxonomy Code106E00000X
TaxonomyAssistant Behavior Analyst
License Number
License Number StateNULL
# 11
Primary TaxonomyN
Taxonomy Code106S00000X
TaxonomyBehavior Technician
License Number602751890124
License Number StateOH

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: