Healthcare Provider Details

I. General information

NPI: 1699450809
Provider Name (Legal Business Name): CIARA DESHA HAMPTON
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 06/16/2023
Last Update Date: 12/19/2023
Certification Date: 12/19/2023
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2125 ASCHINGER BLVD
COLUMBUS OH
43212-2678
US

IV. Provider business mailing address

2125 ASCHINGER BLVD
COLUMBUS OH
43212-2678
US

V. Phone/Fax

Practice location:
  • Phone: 540-263-3245
  • Fax:
Mailing address:
  • Phone: 540-263-3245
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code347C00000X
TaxonomyPrivate Vehicle
License Number
License Number StateNULL
# 2
Primary TaxonomyY
Taxonomy Code3747P1801X
TaxonomyPersonal Care Attendant
License Number
License Number StateNULL
# 3
Primary TaxonomyN
Taxonomy Code171M00000X
TaxonomyCase Manager/Care Coordinator
License Number
License Number StateNULL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: