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General NPI Number Information
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NPI Number | 1851016687
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Entity Type | Organization
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Legal Business Name | LIBERTY HOMES OHIO
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Dates
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Enumeration Date | 10/04/2022
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Last Update Date | 10/04/2022
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Provider Practice Location Address
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Address Line | 4758 ECHOROCK DR
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City | COLUMBUS
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State | OH
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Zip | 43231-5957
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Country | US
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Telephone | 614-218-8070
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Fax |
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Provider Business Mailing Address
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Address Line | 4758 ECHOROCK DR
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City | COLUMBUS
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State | OH
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Zip | 43231-5957
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Country | US
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Telephone | 614-218-8070
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Fax |
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Authorized Official
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Title or Position | CEO
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Name | MR. DURRELL WAJI
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Credential | MR.
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Telephone | 614-218-8070
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 282J00000X
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Taxonomy Name | Religious Nonmedical Health Care Institution
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License Number |
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License Number State |
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