Provider Demographics
NPI:1194502187
Name:QUEENS REHOBOTH
Entity type:Organization
Organization Name:QUEENS REHOBOTH
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:DOO
Authorized Official - Prefix:
Authorized Official - First Name:ESTHER
Authorized Official - Middle Name:TAKYIWAA
Authorized Official - Last Name:ARYETEY
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:513-668-5907
Mailing Address - Street 1:3903 MACK RD APT 75
Mailing Address - Street 2:
Mailing Address - City:FAIRFIELD
Mailing Address - State:OH
Mailing Address - Zip Code:45014-6669
Mailing Address - Country:US
Mailing Address - Phone:513-668-5907
Mailing Address - Fax:
Practice Address - Street 1:3903 MACK RD APT 75
Practice Address - Street 2:
Practice Address - City:FAIRFIELD
Practice Address - State:OH
Practice Address - Zip Code:45014-6669
Practice Address - Country:US
Practice Address - Phone:513-668-5907
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2023-09-12
Last Update Date:2024-04-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes251E00000XAgenciesHome Health