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General NPI Number Information
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NPI Number | 1194515205
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Entity Type | Organization
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Legal Business Name | KTM SUPPORT GROUP, LLC
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Dates
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Enumeration Date | 05/12/2025
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Last Update Date | 05/12/2025
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Provider Practice Location Address
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Address Line | 5300 E MAIN ST STE 204B
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City | COLUMBUS
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State | OH
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Zip | 43213-2580
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Country | US
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Telephone | 614-598-9900
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Fax |
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Provider Business Mailing Address
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Address Line | 5300 E MAIN ST STE 204B
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City | COLUMBUS
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State | OH
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Zip | 43213-2580
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Country | US
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Telephone |
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Fax |
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Authorized Official
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Title or Position | OWNER
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Name | DAME CISSE
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Credential |
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Telephone | 614-598-9900
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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 |
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