MEDICARE: GALASSA GABISSA JIBRARUK HOME HEALTH AIDE

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	376K00000X	Nurse's Aide	3651757	OH

General Provider Information

NPI Number	:	1508647975
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	GALASSA GABISSA JIBRARUK HOME HEALTH AIDE

Provider Business Mailing Address
First Line	:	4887 BETSY DR
Second Line	:
City	:	COLUMBUS
State	:	OH
Zip	:	43227-2122
Country	:	US
Telephone Number	:	220-262-2954
Fax Number	:

Provider Business Practice Location Address
First Line	:	4887 BETSY DR
Second Line	:
City	:	COLUMBUS
State	:	OH
Zip	:	43227-2122
Country	:	US
Telephone Number	:	220-262-2954
Fax Number	:

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

Provider Enumeration Date	:	10/11/2023
Last Update Date	:	12/26/2024

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