Healthcare Provider Details

I. General information

NPI: 1568161420
Provider Name (Legal Business Name): ANDIAMO HEALTHCARE
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 03/01/2023
Last Update Date: 12/18/2023
Certification Date: 12/18/2023
Deactivation Date:
Reactivation Date:

III. Provider practice location address

6210 BELLEFONTAINE RD
HUBER HEIGHTS OH
45424-4009
US

IV. Provider business mailing address

5710 STONE LAKE DR
CENTERVILLE OH
45429-6053
US

V. Phone/Fax

Practice location:
  • Phone: 330-329-7980
  • Fax:
Mailing address:
  • Phone: 330-329-7980
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207R00000X
TaxonomyInternal Medicine Physician
License Number
License Number State
# 2
Primary TaxonomyN
Taxonomy Code261QM0850X
TaxonomyAdult Mental Health Clinic/Center
License Number
License Number State
# 3
Primary TaxonomyN
Taxonomy Code320800000X
TaxonomyMental Illness Community Based Residential Treatment Facility
License Number
License Number State
# 4
Primary TaxonomyN
Taxonomy Code363L00000X
TaxonomyNurse Practitioner
License Number
License Number State

VIII. Authorized Official

Name: DR. ANGELA M PALITTO
Title or Position: PHYSICIAN OWNER
Credential: DO
Phone: 330-329-7980