Healthcare Provider Details

I. General information

NPI: 1841036506
Provider Name (Legal Business Name): RAHAF GHENTAWI
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

Provider Other Name: RAHAF GHENTAWI

II. Dates (important events)

Enumeration Date: 07/02/2024
Last Update Date: 07/02/2024
Certification Date: 07/02/2024
Deactivation Date:
Reactivation Date:

III. Provider practice location address

8338 WOODGROVE CT
SUGARCREEK TOWNSHIP OH
45458-1823
US

IV. Provider business mailing address

8338 WOODGROVE CT
SUGARCREEK TOWNSHIP OH
45458-1823
US

V. Phone/Fax

Practice location:
  • Phone: 937-979-0704
  • Fax:
Mailing address:
  • Phone: 937-979-0704
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code343900000X
TaxonomyNon-emergency Medical Transport (VAN)
License Number202418402810
License Number StateOH

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: