Healthcare Provider Details

I. General information

NPI: 1689144065
Provider Name (Legal Business Name): VACMI EXTENDED FAMILY INC.
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 11/28/2018
Last Update Date: 03/08/2019
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

4770 INDIANOLA AVE STE 290
COLUMBUS OH
43214-1862
US

IV. Provider business mailing address

4770 INDIANOLA AVE STE 290
COLUMBUS OH
43214-1862
US

V. Phone/Fax

Practice location:
  • Phone: 614-375-2057
  • Fax:
Mailing address:
  • Phone: 614-375-2057
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code372600000X
TaxonomyAdult Companion
License Number
License Number State
# 2
Primary TaxonomyN
Taxonomy Code376J00000X
TaxonomyHomemaker
License Number
License Number State
# 3
Primary TaxonomyN
Taxonomy Code385H00000X
TaxonomyRespite Care
License Number
License Number State

VIII. Authorized Official

Name: KOMLAN INNOCENT SEGOH
Title or Position: PRESIDENT
Credential:
Phone: 614-375-3049