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General NPI Number Information
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NPI Number | 1073913539
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Entity Type | Organization
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Legal Business Name | SAMIRA ADULT FOSTER HOME, LLC
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Dates
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Enumeration Date | 09/02/2014
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Last Update Date | 09/08/2014
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Provider Practice Location Address
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Address Line | 4258 COLBY AVE
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City | COLUMBUS
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State | OH
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Zip | 43227-2028
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Country | US
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Telephone | 614-596-3340
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Fax |
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Provider Business Mailing Address
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Address Line | 4258 COLBY AVE
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City | COLUMBUS
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State | OH
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Zip | 43227-2028
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Country | US
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Telephone | 614-596-3340
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Fax |
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Authorized Official
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Title or Position | PRESIDENT
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Name | MRS. HALIMATOU WHITE
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Credential |
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Telephone | 614-596-3340
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 251E00000X
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Taxonomy Name | Home Health Agency
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License Number |
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License Number State | OH
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