Provider Demographics
NPI:1326417742
Name:EASE HEALTHCARE
Entity Type:Organization
Organization Name:EASE HEALTHCARE
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:DIRECTOR
Authorized Official - Prefix:
Authorized Official - First Name:AYO ABIMBOLLA
Authorized Official - Middle Name:
Authorized Official - Last Name:BISHI
Authorized Official - Suffix:
Authorized Official - Credentials:MBA, MHA
Authorized Official - Phone:573-808-0482
Mailing Address - Street 1:22 BROADWAY VILLAGE DR APT B
Mailing Address - Street 2:
Mailing Address - City:COLUMBIA
Mailing Address - State:MO
Mailing Address - Zip Code:65201-8650
Mailing Address - Country:US
Mailing Address - Phone:
Mailing Address - Fax:
Practice Address - Street 1:22 BROADWAY VILLAGE DR APT B
Practice Address - Street 2:APT B
Practice Address - City:COLUMBIA
Practice Address - State:MO
Practice Address - Zip Code:65201-8650
Practice Address - Country:US
Practice Address - Phone:573-808-0482
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2015-09-15
Last Update Date:2015-09-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes251E00000XAgenciesHome Health
No251C00000XAgenciesDay Training, Developmentally Disabled Services