Provider Demographics
NPI:1043905805
Name:OPOSSUM CARE LLC
Entity Type:Organization
Organization Name:OPOSSUM CARE LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:DOO/OWNER
Authorized Official - Prefix:
Authorized Official - First Name:MADUSU
Authorized Official - Middle Name:
Authorized Official - Last Name:MANSARAY
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:614-313-6591
Mailing Address - Street 1:3012 BLAKEHOPE DR
Mailing Address - Street 2:
Mailing Address - City:COLUMBUS
Mailing Address - State:OH
Mailing Address - Zip Code:43219-7381
Mailing Address - Country:US
Mailing Address - Phone:614-313-6591
Mailing Address - Fax:866-315-9377
Practice Address - Street 1:3012 BLAKEHOPE DR
Practice Address - Street 2:
Practice Address - City:COLUMBUS
Practice Address - State:OH
Practice Address - Zip Code:43219-7381
Practice Address - Country:US
Practice Address - Phone:614-313-6591
Practice Address - Fax:866-315-9377
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2023-04-07
Last Update Date:2023-04-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes253Z00000XAgenciesIn Home Supportive Care
No315P00000XNursing & Custodial Care FacilitiesIntermediate Care Facility, Intellectual Disabilities
No342000000XTransportation ServicesTransportation Network Company
No347C00000XTransportation ServicesPrivate Vehicle
No347E00000XTransportation ServicesTransportation Broker