Healthcare Provider Details

I. General information

NPI: 1629769013
Provider Name (Legal Business Name): VICAMET SOLUTIONS LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 05/16/2023
Last Update Date: 09/08/2025
Certification Date: 09/08/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

4252 EXECUTIVE PKWY APT 518
WESTERVILLE OH
43081-3876
US

IV. Provider business mailing address

4252 EXECUTIVE PKWY APT 518
WESTERVILLE OH
43081-3876
US

V. Phone/Fax

Practice location:
  • Phone: 949-732-8937
  • Fax:
Mailing address:
  • Phone: 949-732-8937
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code251C00000X
TaxonomyDevelopmentally Disabled Services Day Training Agency
License Number
License Number State
# 2
Primary TaxonomyN
Taxonomy Code251E00000X
TaxonomyHome Health Agency
License Number
License Number State

VIII. Authorized Official

Name: KOFI ODURO
Title or Position: MANAGING MEMBER
Credential:
Phone: 949-732-8937