Organization
HUDA
Active
Organization subpart
No
Provider details
NPI number
Authorized official
SABRIN A MIRE (REPRESENTATIVE)
(614) 966-0390
Entity
Organization
Contact information
Practice address
5617 COUNTRIE GLEN DR, GALLOWAY, OH 43119-9068
(614) 966-0390
Mailing address
5617 COUNTRIE GLEN DR, GALLOWAY, OH 43119-9068
(614) 966-0390
Taxonomy
Speciality
Code
Description
License number
State
174200000X
Meals Provider
—
—
251E00000X
Home Health Agency
—
—
253Z00000X
In Home Supportive Care Agency
—
—
261QA0600X
Adult Day Care Clinic/Center
Primary
—
—
261QM0855X
Adolescent and Children Mental Health Clinic/Center
—
—
374U00000X
Home Health Aide
—
—
Other
Enumeration date
08/14/2023
Last updated
08/14/2023
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