Provider Demographics
NPI:1235837329
Name:NAITE, MOHAMED LAMINE (CEO)
Entity Type:Individual
Prefix:MR
First Name:MOHAMED
Middle Name:LAMINE
Last Name:NAITE
Suffix:
Gender:M
Credentials:CEO
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:6908 IDLELEA DR
Mailing Address - Street 2:
Mailing Address - City:REYNOLDSBURG
Mailing Address - State:OH
Mailing Address - Zip Code:43068-8247
Mailing Address - Country:US
Mailing Address - Phone:614-376-9241
Mailing Address - Fax:
Practice Address - Street 1:6908 IDLELEA DR
Practice Address - Street 2:
Practice Address - City:REYNOLDSBURG
Practice Address - State:OH
Practice Address - Zip Code:43068-8247
Practice Address - Country:US
Practice Address - Phone:614-376-9241
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2023-02-20
Last Update Date:2023-02-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OH2567968251S00000X, 253Z00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes251S00000XAgenciesCommunity/Behavioral Health
No253Z00000XAgenciesIn Home Supportive Care
Provider Identifiers
StateIdentifier IDID TypeIssuer
OH2567968OtherCONTRACT NUMBER