Provider Demographics
NPI:1508647975
Name:JIBRARUK, GALASSA GABISSA (HOME HEALTH AIDE)
Entity type:Individual
Prefix:
First Name:GALASSA
Middle Name:GABISSA
Last Name:JIBRARUK
Suffix:
Gender:M
Credentials:HOME HEALTH AIDE
Other - Prefix:
Other - First Name:TADESSE
Other - Middle Name:TEKLU
Other - Last Name:GEBREYESUS
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:4887 BETSY DR
Mailing Address - Street 2:
Mailing Address - City:COLUMBUS
Mailing Address - State:OH
Mailing Address - Zip Code:43227-2122
Mailing Address - Country:US
Mailing Address - Phone:220-262-2954
Mailing Address - Fax:
Practice Address - Street 1:4887 BETSY DR
Practice Address - Street 2:
Practice Address - City:COLUMBUS
Practice Address - State:OH
Practice Address - Zip Code:43227-2122
Practice Address - Country:US
Practice Address - Phone:220-262-2954
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2023-10-11
Last Update Date:2024-12-26
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OH3651757376K00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes376K00000XNursing Service Related ProvidersNurse's AideGroup - Single Specialty