MEDICARE: MICHAEL MAKEBA

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

General Provider Information

NPI Number	:	1992863617
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	MICHAEL MAKEBA

Provider Business Mailing Address
First Line	:	1005 E LONG ST
Second Line	:	SUITE 3
City	:	COLUMBUS
State	:	OH
Zip	:	43203-1835
Country	:	US
Telephone Number	:	614-604-2899
Fax Number	:

Provider Business Practice Location Address
First Line	:	1005 E LONG ST
Second Line	:	SUITE 3
City	:	COLUMBUS
State	:	OH
Zip	:	43203-1835
Country	:	US
Telephone Number	:	614-604-2899
Fax Number	:

Authorized Official
Title or Position	:	OWNER
Name	:	MR. MICHAEL MAKEBA
Credential	:
Telephone Number	:	614-604-2899

Provider Enumeration Date	:	12/05/2006
Last Update Date	:	08/22/2020

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