Healthcare Provider Details

I. General information

NPI: 1245597541
Provider Name (Legal Business Name): OKIMAH WINN
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 04/12/2012
Last Update Date: 04/12/2012
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

5395 REFUGEE RD
COLUMBUS OH
43232-4725
US

IV. Provider business mailing address

5395 REFUGEE RD
COLUMBUS OH
43232-4725
US

V. Phone/Fax

Practice location:
  • Phone: 614-377-9824
  • Fax:
Mailing address:
  • Phone: 614-377-9824
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code3140N1450X
TaxonomyPediatric Skilled Nursing Facility
License NumberP.N.148493
License Number StateOH

VIII. Authorized Official

Name: MS. OKIMAH JOYEL WINN
Title or Position: LPN
Credential:
Phone: 614-377-9824