Provider Demographics
NPI:1285018572
Name:INDEPENDENT PROVIDER
Entity Type:Organization
Organization Name:INDEPENDENT PROVIDER
Other - Org Name:EMMA
Other - Org Type:Doing Business As
Authorized Official - Title/Position:STNA
Authorized Official - Prefix:
Authorized Official - First Name:EMMA
Authorized Official - Middle Name:HAJA
Authorized Official - Last Name:WURIE
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:614-783-8961
Mailing Address - Street 1:4175 ARBURY LN
Mailing Address - Street 2:
Mailing Address - City:COLUMBUS
Mailing Address - State:OH
Mailing Address - Zip Code:43224-1704
Mailing Address - Country:US
Mailing Address - Phone:614-783-8961
Mailing Address - Fax:
Practice Address - Street 1:4175 ARBURY LANE
Practice Address - Street 2:
Practice Address - City:COLUMBUS
Practice Address - State:OH
Practice Address - Zip Code:43224
Practice Address - Country:US
Practice Address - Phone:614-783-8961
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:Yes
Parent Organization LBN:INDEPENDENT PROVER
Parent Organization TIN:<UNAVAIL>
Enumeration Date:2015-07-16
Last Update Date:2015-07-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes251E00000XAgenciesHome Health