MEDICARE: SHIFO HEALTHCARE SERVICES, LLC

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	1663020	OH

General Provider Information

NPI Number	:	1306903943
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	SHIFO HEALTHCARE SERVICES, LLC

Provider Business Mailing Address
First Line	:	PO BOX 11643
Second Line	:
City	:	COLUMBUS
State	:	OH
Zip	:	43211-0643
Country	:	US
Telephone Number	:	614-207-9614
Fax Number	:	614-351-9998

Provider Business Practice Location Address
First Line	:	3850 SULLIVANT AVE
Second Line	:	SUITE# 106
City	:	COLUMBUS
State	:	OH
Zip	:	43228-4327
Country	:	US
Telephone Number	:	614-207-9614
Fax Number	:	614-351-9998

Authorized Official
Title or Position	:	CEO
Name	:	MR. ABDULKADIR HAJI ELMI
Credential	:
Telephone Number	:	614-207-9614

Provider Enumeration Date	:	01/02/2007
Last Update Date	:	08/22/2020

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