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General NPI Number Information
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NPI Number | 1760900211
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Entity Type | Organization
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Legal Business Name | CENTRA HOME HEALTH CARE, LLC
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Dates
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Enumeration Date | 09/05/2017
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Last Update Date | 09/05/2017
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Provider Practice Location Address
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Address Line | 4745 LEGARE LN
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City | COLUMBUS
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State | OH
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Zip | 43230
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Country | US
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Telephone | 409-454-5611
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Fax |
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Provider Business Mailing Address
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Address Line | 4745 LEGARE LN
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City | COLUMBUS
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State | OH
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Zip | 43230-6387
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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 | CHIEF EXECUTIVE OFFICER
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Name | KAREN DANISE MABATAH
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Credential | REGISTERED NURSE
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Telephone | 409-454-5611
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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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