Healthcare Provider Details

I. General information

NPI: 1467159624
Provider Name (Legal Business Name): LE'AIH VERNICE HAIRSTON
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 02/08/2023
Last Update Date: 07/02/2026
Certification Date: 10/22/2024
Deactivation Date: 05/25/2026
Reactivation Date: 07/02/2026

III. Provider practice location address

821 BERKELEY RD
COLUMBUS OH
43205-2902
US

IV. Provider business mailing address

2846 BANWICK RD
COLUMBUS OH
43232-3805
US

V. Phone/Fax

Practice location:
  • Phone: 380-209-8040
  • Fax:
Mailing address:
  • Phone: 380-209-8040
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code251E00000X
TaxonomyHome Health Agency
License Number0327381
License Number StateOH
# 2
Primary TaxonomyN
Taxonomy Code376G00000X
TaxonomyNursing Home Administrator
License Number
License Number StateNULL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: