Provider Demographics
NPI:1114108859
Name:MOOREHEAD, JAMES A (HHA)
Entity Type:Individual
Prefix:
First Name:JAMES
Middle Name:A
Last Name:MOOREHEAD
Suffix:
Gender:M
Credentials:HHA
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:3800 PETZINGER RD
Mailing Address - Street 2:
Mailing Address - City:COLUMBUS
Mailing Address - State:OH
Mailing Address - Zip Code:43232-4266
Mailing Address - Country:US
Mailing Address - Phone:614-759-8665
Mailing Address - Fax:
Practice Address - Street 1:3800 PETZINGER RD
Practice Address - Street 2:
Practice Address - City:COLUMBUS
Practice Address - State:OH
Practice Address - Zip Code:43232-4266
Practice Address - Country:US
Practice Address - Phone:614-759-8665
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2007-11-23
Last Update Date:2007-11-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes374U00000XNursing Service Related ProvidersHome Health Aide