=====================================================
General NPI Number Information
=====================================================
NPI Number | 1528273596
-----------------------------------------------------
Entity Type | Organization
-----------------------------------------------------
Legal Business Name | ULTIMATE TOO, INC.
-----------------------------------------------------
=====================================================
Dates
=====================================================
Enumeration Date | 05/13/2007
-----------------------------------------------------
Last Update Date | 08/22/2020
-----------------------------------------------------
=====================================================
Provider Practice Location Address
=====================================================
Address Line | 2238 S HAMILTON RD SUITE 102
-----------------------------------------------------
City | COLUMBUS
-----------------------------------------------------
State | OH
-----------------------------------------------------
Zip | 43232-4382
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 614-868-6970
-----------------------------------------------------
Fax | 614-868-6980
-----------------------------------------------------
=====================================================
Provider Business Mailing Address
=====================================================
Address Line | 2238 S HAMILTON RD SUITE 102
-----------------------------------------------------
City | COLUMBUS
-----------------------------------------------------
State | OH
-----------------------------------------------------
Zip | 43232-4382
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 614-868-6970
-----------------------------------------------------
Fax | 614-868-6980
-----------------------------------------------------
=====================================================
Authorized Official
=====================================================
Title or Position | PRESIDENT & CEO
-----------------------------------------------------
Name | MR. TAMBA TANDANPOLIE
-----------------------------------------------------
Credential | MBA
-----------------------------------------------------
Telephone | 614-218-7002
-----------------------------------------------------
=====================================================
Scope of Practice (Provider's specialty)
=====================================================
Taxonomy #1
-----------------------------------------------------
Taxonomy Code | 251E00000X
-----------------------------------------------------
Taxonomy Name | Home Health Agency
-----------------------------------------------------
License Number |
-----------------------------------------------------
License Number State |
-----------------------------------------------------