Individual
MR. KENNETH PAUL IGUMBOR
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
Man
Contact information
Practice address
1110 MOSS ROAD, SUITE 120B, COLUMBUS, OH 43229
(614) 772-1261
Mailing address
1110 MOSS ROAD, SUITE 120B, COLUMBUS, OH 43229
(614) 772-1261
Taxonomy
Speciality
Code
Description
License number
State
172A00000X
Driver
—
OH
174200000X
Meals Provider
—
OH
251E00000X
Home Health Agency
—
OH
251X00000X
Supports Brokerage Agency
—
OH
253Z00000X
In Home Supportive Care Agency
Primary
—
OH
3104A0630X
Assisted Living Facility (Behavioral Disturbances)
—
OH
347C00000X
Private Vehicle
—
OH
372500000X
Chore Provider
—
OH
Other
Enumeration date
09/13/2017
Last updated
07/21/2022
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