Healthcare Provider Details

I. General information

NPI: 1124846894
Provider Name (Legal Business Name): MUMTAZ ACTIVE CENTER, LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 10/01/2024
Last Update Date: 07/11/2025
Certification Date: 07/11/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

653 HARRISBURG PIKE
COLUMBUS OH
43223-2103
US

IV. Provider business mailing address

653 HARRISBURG PIKE
COLUMBUS OH
43223-2103
US

V. Phone/Fax

Practice location:
  • Phone: 380-239-6083
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code261QA0600X
TaxonomyAdult Day Care Clinic/Center
License Number
License Number State

VIII. Authorized Official

Name: AMINO MOHAMED
Title or Position: OWNER
Credential:
Phone: 380-239-6083