Provider Demographics
NPI:1770941122
Name:ACHU SAMBS 5
Entity type:Organization
Organization Name:ACHU SAMBS 5
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PROJECT ADMINISTRATOR
Authorized Official - Prefix:
Authorized Official - First Name:FNU
Authorized Official - Middle Name:
Authorized Official - Last Name:ACHU SAMBA
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:614-966-0652
Mailing Address - Street 1:7938 OAK VALLEY RD
Mailing Address - Street 2:
Mailing Address - City:REYNOLDSBURG
Mailing Address - State:OH
Mailing Address - Zip Code:43068-1578
Mailing Address - Country:US
Mailing Address - Phone:614-966-0652
Mailing Address - Fax:
Practice Address - Street 1:7938 OAK VALLEY RD
Practice Address - Street 2:
Practice Address - City:REYNOLDSBURG
Practice Address - State:OH
Practice Address - Zip Code:43068-1578
Practice Address - Country:US
Practice Address - Phone:614-966-0652
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2016-01-31
Last Update Date:2016-01-31
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes251E00000XAgenciesHome Health