Provider Demographics
NPI:1669800785
Name:PERIS GITAHI
Entity type:Organization
Organization Name:PERIS GITAHI
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:DIRECT CARE STAFF
Authorized Official - Prefix:MRS
Authorized Official - First Name:PERIS
Authorized Official - Middle Name:WANGECI
Authorized Official - Last Name:GITAHI
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:614-556-3325
Mailing Address - Street 1:3380 BRUCETON AVE
Mailing Address - Street 2:3380 BRUCETON AVENUE
Mailing Address - City:COLUMBUS
Mailing Address - State:OH
Mailing Address - Zip Code:43232-4059
Mailing Address - Country:US
Mailing Address - Phone:614-556-3325
Mailing Address - Fax:
Practice Address - Street 1:3380 BRUCETON AVE
Practice Address - Street 2:3380 BRUCETON AVENUE
Practice Address - City:COLUMBUS
Practice Address - State:OH
Practice Address - Zip Code:43232-4059
Practice Address - Country:US
Practice Address - Phone:614-556-3325
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2013-10-29
Last Update Date:2013-10-29
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes320600000XResidential Treatment FacilitiesResidential Treatment Facility, Intellectual and/or Developmental Disabilities