Provider Demographics
NPI:1114448552
Name:KARGBO, SARAH
Entity Type:Individual
Prefix:
First Name:SARAH
Middle Name:
Last Name:KARGBO
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:4817 KINGSHILL DR APT F
Mailing Address - Street 2:
Mailing Address - City:COLUMBUS
Mailing Address - State:OH
Mailing Address - Zip Code:43229-7210
Mailing Address - Country:US
Mailing Address - Phone:614-432-1615
Mailing Address - Fax:
Practice Address - Street 1:6000 RIVERSIDE DR
Practice Address - Street 2:FRIENDSHIP VILLAGE OF DUBLIM
Practice Address - City:DUBLIN
Practice Address - State:OH
Practice Address - Zip Code:43017
Practice Address - Country:US
Practice Address - Phone:614-764-1600
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2017-07-06
Last Update Date:2017-07-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OH401813861215376K00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes376K00000XNursing Service Related ProvidersNurse's Aide