Healthcare Provider Details

I. General information

NPI: 1245772375
Provider Name (Legal Business Name): RANADA LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 11/07/2016
Last Update Date: 11/07/2016
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

17 VANDERBILT DRIVE APT G
FAIRBORN OH
45324
US

IV. Provider business mailing address

PO BOX 681
SPRINGFIELD OH
45501
US

V. Phone/Fax

Practice location:
  • Phone: 614-506-2494
  • Fax:
Mailing address:
  • Phone: 614-506-2494
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code302F00000X
TaxonomyExclusive Provider Organization
License Number2357920
License Number StateOH
# 2
Primary TaxonomyN
Taxonomy Code302R00000X
TaxonomyHealth Maintenance Organization
License Number2357920
License Number StateOH

VIII. Authorized Official

Name: MISS SENIKA RANADA CHANNELS
Title or Position: OWNER
Credential:
Phone: 614-506-2494