Provider Demographics
NPI:1316241631
Name:ACQUAH, SAMUEL RICHARD (MBA)
Entity type:Individual
Prefix:
First Name:SAMUEL
Middle Name:RICHARD
Last Name:ACQUAH
Suffix:
Gender:M
Credentials:MBA
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:5272 CLEVELAND AVE
Mailing Address - Street 2:
Mailing Address - City:COLUMBUS
Mailing Address - State:OH
Mailing Address - Zip Code:43231-4737
Mailing Address - Country:US
Mailing Address - Phone:614-657-5950
Mailing Address - Fax:
Practice Address - Street 1:5272 CLEVELAND AVE
Practice Address - Street 2:2200 WALFORD LN 201 COLUMBUS OHIO 43224
Practice Address - City:COLUMBUS
Practice Address - State:OH
Practice Address - Zip Code:43231-4737
Practice Address - Country:US
Practice Address - Phone:614-657-5950
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2010-12-29
Last Update Date:2010-12-29
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OH376J00000X374U00000X
OH376K00000X376J00000X
376K00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes374U00000XNursing Service Related ProvidersHome Health Aide
No376J00000XNursing Service Related ProvidersHomemaker
No376K00000XNursing Service Related ProvidersNurse's Aide