=====================================================
General NPI Number Information
=====================================================
NPI Number | 1134017676
-----------------------------------------------------
Entity Type | Organization
-----------------------------------------------------
Legal Business Name | MOSFA
-----------------------------------------------------
=====================================================
Dates
=====================================================
Enumeration Date | 06/24/2025
-----------------------------------------------------
Last Update Date | 06/24/2025
-----------------------------------------------------
=====================================================
Provider Practice Location Address
=====================================================
Address Line | 2024 N WESTWOOD AVE
-----------------------------------------------------
City | TOLEDO
-----------------------------------------------------
State | OH
-----------------------------------------------------
Zip | 43607-1213
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 360-612-2118
-----------------------------------------------------
Fax |
-----------------------------------------------------
=====================================================
Provider Business Mailing Address
=====================================================
Address Line | 2024 N WESTWOOD AVE
-----------------------------------------------------
City | TOLEDO
-----------------------------------------------------
State | OH
-----------------------------------------------------
Zip | 43607-1213
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 360-612-2118
-----------------------------------------------------
Fax |
-----------------------------------------------------
=====================================================
Authorized Official
=====================================================
Title or Position | MANANGER
-----------------------------------------------------
Name | FAITH CHESEREM
-----------------------------------------------------
Credential |
-----------------------------------------------------
Telephone | 360-612-2118
-----------------------------------------------------
=====================================================
Scope of Practice (Provider's specialty)
=====================================================
Taxonomy #1
-----------------------------------------------------
Taxonomy Code | 374U00000X
-----------------------------------------------------
Taxonomy Name | Home Health Aide
-----------------------------------------------------
License Number |
-----------------------------------------------------
License Number State |
-----------------------------------------------------