MEDICARE: SAMUEL RICHARD ACQUAH MBA

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	374U00000X	Home Health Aide	376J00000X	OH
2	376J00000X	Homemaker	376K00000X	OH
3	376K00000X	Nurse's Aide

General Provider Information

NPI Number	:	1316241631
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	SAMUEL RICHARD ACQUAH MBA

Provider Business Mailing Address
First Line	:	5272 CLEVELAND AVE
Second Line	:
City	:	COLUMBUS
State	:	OH
Zip	:	43231-4737
Country	:	US
Telephone Number	:	614-657-5950
Fax Number	:

Provider Business Practice Location Address
First Line	:	5272 CLEVELAND AVE
Second Line	:	2200 WALFORD LN 201 COLUMBUS OHIO 43224
City	:	COLUMBUS
State	:	OH
Zip	:	43231-4737
Country	:	US
Telephone Number	:	614-657-5950
Fax Number	:

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	12/29/2010
Last Update Date	:	12/29/2010

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