Healthcare Provider Details

I. General information

NPI: 1427668581
Provider Name (Legal Business Name): JUDE ASAH
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 08/04/2020
Last Update Date: 08/20/2021
Certification Date: 08/20/2021
Deactivation Date:
Reactivation Date:

III. Provider practice location address

3930 GRANDVIEW CT
TOLEDO OH
43614-3338
US

IV. Provider business mailing address

3930 GRANDVIEW CT
TOLEDO OH
43614-3338
US

V. Phone/Fax

Practice location:
  • Phone: 419-470-9860
  • Fax:
Mailing address:
  • Phone: 419-470-9860
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code251E00000X
TaxonomyHome Health Agency
License Number4519008
License Number StateOH
# 2
Primary TaxonomyN
Taxonomy Code343900000X
TaxonomyNon-emergency Medical Transport (VAN)
License Number4519008
License Number StateOH
# 3
Primary TaxonomyN
Taxonomy Code385H00000X
TaxonomyRespite Care
License Number4519008
License Number StateOH
# 4
Primary TaxonomyN
Taxonomy Code164W00000X
TaxonomyLicensed Practical Nurse
License Number169917
License Number StateOH

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: