Provider Demographics
NPI:1255532586
Name:EASTON HEALTHCARE AGENCY, INC
Entity type:Organization
Organization Name:EASTON HEALTHCARE AGENCY, INC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:CEO
Authorized Official - Prefix:
Authorized Official - First Name:ANTIONETTE
Authorized Official - Middle Name:
Authorized Official - Last Name:OPOKU SIAW
Authorized Official - Suffix:
Authorized Official - Credentials:DON
Authorized Official - Phone:614-880-9402
Mailing Address - Street 1:2021 E DUBLIN GRANVILLE RD STE 290
Mailing Address - Street 2:
Mailing Address - City:COLUMBUS
Mailing Address - State:OH
Mailing Address - Zip Code:43229-3568
Mailing Address - Country:US
Mailing Address - Phone:614-880-9402
Mailing Address - Fax:614-880-9401
Practice Address - Street 1:2021 E DUBLIN GRANVILLE RD STE 290
Practice Address - Street 2:
Practice Address - City:COLUMBUS
Practice Address - State:OH
Practice Address - Zip Code:43229
Practice Address - Country:US
Practice Address - Phone:614-880-9402
Practice Address - Fax:614-880-9401
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-05-31
Last Update Date:2018-07-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OH36-8177251E00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes251E00000XAgenciesHome Health
Provider Identifiers
StateIdentifier IDID TypeIssuer
OH1255532986Medicaid
OH2736945Medicaid
OH368177Medicare Oscar/Certification