Healthcare Provider Details

I. General information

NPI: 1417345356
Provider Name (Legal Business Name): NURSING AID
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 12/30/2014
Last Update Date: 12/30/2014
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

410 WATERSWAY LANE
COLUMBUS OH
43213
US

IV. Provider business mailing address

410 WATERSWAY LN
COLUMBUS OH
43213-6644
US

V. Phone/Fax

Practice location:
  • Phone: 614-589-4874
  • Fax:
Mailing address:
  • Phone: 614-589-4874
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code311ZA0620X
TaxonomyAdult Care Home Facility
License Number401273120711
License Number StateOH

VIII. Authorized Official

Name: MR. FIKRE WORKU FETENE
Title or Position: NURSE AID
Credential: NURSE AID
Phone: 614-589-4874