=====================================================
General NPI Number Information
=====================================================
NPI Number | 1033621636
-----------------------------------------------------
Entity Type | Organization
-----------------------------------------------------
Legal Business Name | BRAVO HEALTHCARE LLC
-----------------------------------------------------
=====================================================
Dates
=====================================================
Enumeration Date | 11/04/2017
-----------------------------------------------------
Last Update Date | 03/07/2024
-----------------------------------------------------
=====================================================
Provider Practice Location Address
=====================================================
Address Line | 2720 AIRPORT DR STE 158
-----------------------------------------------------
City | COLUMBUS
-----------------------------------------------------
State | OH
-----------------------------------------------------
Zip | 43219-2219
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 614-934-5041
-----------------------------------------------------
Fax | 614-779-0574
-----------------------------------------------------
=====================================================
Provider Business Mailing Address
=====================================================
Address Line | 2720 AIRPORT DR STE 158
-----------------------------------------------------
City | COLUMBUS
-----------------------------------------------------
State | OH
-----------------------------------------------------
Zip | 43219-2219
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 614-934-5041
-----------------------------------------------------
Fax | 614-591-3702
-----------------------------------------------------
=====================================================
Authorized Official
=====================================================
Title or Position | CEO
-----------------------------------------------------
Name | ARJUN SUBEDI
-----------------------------------------------------
Credential |
-----------------------------------------------------
Telephone | 614-934-5041
-----------------------------------------------------
=====================================================
Scope of Practice (Provider's specialty)
=====================================================
Taxonomy #1
-----------------------------------------------------
Taxonomy Code | 251E00000X
-----------------------------------------------------
Taxonomy Name | Home Health Agency
-----------------------------------------------------
License Number |
-----------------------------------------------------
License Number State |
-----------------------------------------------------