MEDICARE: CARITAS HOME HEALTH CARE AND SUPPORTED LIVING

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	251E00000X	Home Health Agency		OH
2	251C00000X	Developmentally Disabled Services Day Training Agency		OH

General Provider Information

NPI Number	:	1063710929
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	CARITAS HOME HEALTH CARE AND SUPPORTED LIVING

Provider Business Mailing Address
First Line	:	4204 POSSUM ROUND CT
Second Line	:
City	:	COLUMBUS
State	:	OH
Zip	:	43224-6820
Country	:	US
Telephone Number	:	614-973-1621
Fax Number	:

Provider Business Practice Location Address
First Line	:	4204 POSSUM RUN CT W
Second Line	:
City	:	COLUMBUS
State	:	OH
Zip	:	43224-6820
Country	:	US
Telephone Number	:	614-973-1621
Fax Number	:

Authorized Official
Title or Position	:	CEO
Name	:	MR. SEKOU BAYOH KPOTO
Credential	:
Telephone Number	:	614-973-1621

Provider Enumeration Date	:	03/02/2011
Last Update Date	:	05/09/2011

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Directions to “CARITAS HOME HEALTH CARE AND SUPPORTED LIVING ” Practice Location

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