Provider Demographics
NPI:1598367864
Name:ARCHIBALD, ALICIA L
Entity Type:Individual
Prefix:
First Name:ALICIA
Middle Name:L
Last Name:ARCHIBALD
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2520 GLENMAWR AVE
Mailing Address - Street 2:
Mailing Address - City:COLUMBUS
Mailing Address - State:OH
Mailing Address - Zip Code:43202-2425
Mailing Address - Country:US
Mailing Address - Phone:513-907-0787
Mailing Address - Fax:
Practice Address - Street 1:2520 GLENMAWR AVE
Practice Address - Street 2:
Practice Address - City:COLUMBUS
Practice Address - State:OH
Practice Address - Zip Code:43202-2425
Practice Address - Country:US
Practice Address - Phone:513-907-0787
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2020-11-12
Last Update Date:2020-11-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes253Z00000XAgenciesIn Home Supportive Care