Provider Demographics
NPI:1003139403
Name:UNIVERSAL MEDICAL STAFFING AGENCY,LLC
Entity Type:Organization
Organization Name:UNIVERSAL MEDICAL STAFFING AGENCY,LLC
Other - Org Name:UNIVERSAL MEDICAL STAFFING & HOME HEALTHCARE LLC
Other - Org Type:Doing Business As
Authorized Official - Title/Position:CEO/DIRECTOR
Authorized Official - Prefix:
Authorized Official - First Name:AMINATA
Authorized Official - Middle Name:
Authorized Official - Last Name:MANSARAY
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:614-274-9092
Mailing Address - Street 1:3886 BROADWAY STE B
Mailing Address - Street 2:
Mailing Address - City:GROVE CITY
Mailing Address - State:OH
Mailing Address - Zip Code:43123-2207
Mailing Address - Country:US
Mailing Address - Phone:614-274-9092
Mailing Address - Fax:614-369-4883
Practice Address - Street 1:3886 BROADWAY STE B
Practice Address - Street 2:
Practice Address - City:GROVE CITY
Practice Address - State:OH
Practice Address - Zip Code:43123-2207
Practice Address - Country:US
Practice Address - Phone:614-274-9092
Practice Address - Fax:614-369-4883
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2010-03-12
Last Update Date:2022-08-01
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
251E00000X, 251J00000X
OH527600712251J00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes251J00000XAgenciesNursing Care
No251E00000XAgenciesHome Health
Provider Identifiers
StateIdentifier IDID TypeIssuer
OH0097868Medicaid