Provider Demographics
NPI:1952940835
Name:NABHCO, LLC
Entity Type:Organization
Organization Name:NABHCO, LLC
Other - Org Name:NABHCO
Other - Org Type:Doing Business As
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:DR
Authorized Official - First Name:LATONYA
Authorized Official - Middle Name:JANETT
Authorized Official - Last Name:CARROLL
Authorized Official - Suffix:
Authorized Official - Credentials:DNP, APRNCNP
Authorized Official - Phone:877-318-0934
Mailing Address - Street 1:1391 W 5TH AVE # 241
Mailing Address - Street 2:
Mailing Address - City:COLUMBUS
Mailing Address - State:OH
Mailing Address - Zip Code:43212-2902
Mailing Address - Country:US
Mailing Address - Phone:877-318-0934
Mailing Address - Fax:888-831-0965
Practice Address - Street 1:2686 CROSSROADS PLAZA DR.
Practice Address - Street 2:
Practice Address - City:COLUMBUS
Practice Address - State:OH
Practice Address - Zip Code:43219-3442
Practice Address - Country:US
Practice Address - Phone:877-318-0934
Practice Address - Fax:888-831-0965
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2019-12-25
Last Update Date:2022-06-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207QA0401XAllopathic & Osteopathic PhysiciansFamily MedicineAddiction MedicineGroup - Multi-Specialty
No207Q00000XAllopathic & Osteopathic PhysiciansFamily MedicineGroup - Multi-Specialty
No363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamilyGroup - Multi-Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
OH0391040Medicaid