Healthcare Provider Details

I. General information

NPI: 1396520896
Provider Name (Legal Business Name): CHARLES ANSAH
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 08/31/2023
Last Update Date: 08/31/2023
Certification Date: 08/31/2023
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2068 TEAKWOOD DR
COLUMBUS OH
43229-3903
US

IV. Provider business mailing address

2068 TEAKWOOD DR
COLUMBUS OH
43229-3903
US

V. Phone/Fax

Practice location:
  • Phone: 614-381-1936
  • Fax:
Mailing address:
  • Phone: 614-381-1936
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code311ZA0620X
TaxonomyAdult Care Home Facility
License Number
License Number State
# 2
Primary TaxonomyY
Taxonomy Code251C00000X
TaxonomyDevelopmentally Disabled Services Day Training Agency
License Number202003603750
License Number StateOH

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: