Healthcare Provider Details

I. General information

NPI: 1043905805
Provider Name (Legal Business Name): OPOSSUM CARE LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 04/07/2023
Last Update Date: 04/07/2023
Certification Date: 03/15/2023
Deactivation Date:
Reactivation Date:

III. Provider practice location address

3012 BLAKEHOPE DR
COLUMBUS OH
43219-7381
US

IV. Provider business mailing address

3012 BLAKEHOPE DR
COLUMBUS OH
43219-7381
US

V. Phone/Fax

Practice location:
  • Phone: 614-313-6591
  • Fax: 866-315-9377
Mailing address:
  • Phone: 614-313-6591
  • Fax: 866-315-9377

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code253Z00000X
TaxonomyIn Home Supportive Care Agency
License Number
License Number State
# 2
Primary TaxonomyN
Taxonomy Code315P00000X
TaxonomyIntellectual Disabilities Intermediate Care Facility
License Number
License Number State
# 3
Primary TaxonomyN
Taxonomy Code342000000X
TaxonomyTransportation Network Company
License Number
License Number State
# 4
Primary TaxonomyN
Taxonomy Code347C00000X
TaxonomyPrivate Vehicle
License Number
License Number State
# 5
Primary TaxonomyN
Taxonomy Code347E00000X
TaxonomyTransportation Broker
License Number
License Number State

VIII. Authorized Official

Name: MADUSU MANSARAY
Title or Position: DOO/OWNER
Credential:
Phone: 614-313-6591