Healthcare Provider Details

I. General information

NPI: 1518884584
Provider Name (Legal Business Name): MRS. CONNIE S RANDALL
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 07/01/2026
Last Update Date: 07/01/2026
Certification Date: 07/01/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2473 CREEKWILLOW PL
GROVE CITY OH
43123-1685
US

IV. Provider business mailing address

2473 CREEKWILLOW PL
GROVE CITY OH
43123-1685
US

V. Phone/Fax

Practice location:
  • Phone: 614-940-1299
  • Fax:
Mailing address:
  • Phone: 614-940-1299
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code253Z00000X
TaxonomyIn Home Supportive Care Agency
License Number
License Number State

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: