Provider Demographics
NPI:1568947703
Name:MANIFEST-STAFF MEDICAL LLC
Entity Type:Organization
Organization Name:MANIFEST-STAFF MEDICAL LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:CEO/MANAGER
Authorized Official - Prefix:
Authorized Official - First Name:ZAMA
Authorized Official - Middle Name:CHRITIAN
Authorized Official - Last Name:OUEDRAOGO
Authorized Official - Suffix:
Authorized Official - Credentials:RN
Authorized Official - Phone:614-654-0160
Mailing Address - Street 1:3325 COURTNEY SUE LN
Mailing Address - Street 2:
Mailing Address - City:CANAL WINCHESTER
Mailing Address - State:OH
Mailing Address - Zip Code:43110-8502
Mailing Address - Country:US
Mailing Address - Phone:614-654-0160
Mailing Address - Fax:
Practice Address - Street 1:3325 COURTNEY SUE LN
Practice Address - Street 2:
Practice Address - City:CANAL WINCHESTER
Practice Address - State:OH
Practice Address - Zip Code:43110-8502
Practice Address - Country:US
Practice Address - Phone:614-654-0160
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2018-10-02
Last Update Date:2018-10-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes163WH0200XNursing Service ProvidersRegistered NurseHome HealthGroup - Single Specialty