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General NPI Number Information
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NPI Number | 1114852647
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Entity Type | Organization
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Legal Business Name | 412 DIRECT CARE LLC
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Dates
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Enumeration Date | 06/16/2026
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Last Update Date | 06/16/2026
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Provider Practice Location Address
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Address Line | 1499 BRENTFIELD DR
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City | WADSWORTH
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State | OH
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Zip | 44281-6204
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Country | US
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Telephone | 412-623-9101
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Fax |
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Provider Business Mailing Address
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Address Line | 1499 BRENTFIELD DR
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City | WADSWORTH
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State | OH
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Zip | 44281-6204
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Country | US
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Telephone | 412-623-9101
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Fax |
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Authorized Official
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Title or Position | CEO
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Name | NCHIMA CHIBAYE
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Credential | CNP
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Telephone | 412-623-9101
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 101YM0800X
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Taxonomy Name | Mental Health Counselor
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License Number |
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License Number State |
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Taxonomy #2
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Taxonomy Code | 163W00000X
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Taxonomy Name | Registered Nurse
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License Number |
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License Number State |
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Taxonomy #3
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Taxonomy Code | 202K00000X
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Taxonomy Name | Phlebology Physician
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License Number |
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License Number State |
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Taxonomy #4
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Taxonomy Code | 363LP2300X
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Taxonomy Name | Primary Care Nurse Practitioner
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License Number |
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License Number State |
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