Healthcare Provider Details

I. General information

NPI: 1366297160
Provider Name (Legal Business Name): CHARLES OGBONNA
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 04/23/2024
Last Update Date: 04/23/2024
Certification Date: 04/23/2024
Deactivation Date:
Reactivation Date:

III. Provider practice location address

333 W STATE ST APT 240
COLUMBUS OH
43215-4236
US

IV. Provider business mailing address

333 W STATE ST APT 240
COLUMBUS OH
43215-4236
US

V. Phone/Fax

Practice location:
  • Phone: 551-209-7139
  • Fax:
Mailing address:
  • Phone: 551-209-7139
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code374U00000X
TaxonomyHome Health Aide
License Number
License Number State

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: