Provider Demographics
NPI:1306863964
Name:NON-AGENCY RN
Entity Type:Organization
Organization Name:NON-AGENCY RN
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:RN
Authorized Official - Prefix:
Authorized Official - First Name:ABU
Authorized Official - Middle Name:B
Authorized Official - Last Name:KALOKOH
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:614-209-6947
Mailing Address - Street 1:4665 E MAIN ST APT 17
Mailing Address - Street 2:
Mailing Address - City:COLUMBUS
Mailing Address - State:OH
Mailing Address - Zip Code:43213-3134
Mailing Address - Country:US
Mailing Address - Phone:614-209-6947
Mailing Address - Fax:
Practice Address - Street 1:4665 E MAIN ST APT 17
Practice Address - Street 2:
Practice Address - City:COLUMBUS
Practice Address - State:OH
Practice Address - Zip Code:43213-3134
Practice Address - Country:US
Practice Address - Phone:614-209-6947
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-07-17
Last Update Date:2020-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OHRN282042314000000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes314000000XNursing & Custodial Care FacilitiesSkilled Nursing Facility
Provider Identifiers
StateIdentifier IDID TypeIssuer
OH2606817Medicaid