Provider Demographics
NPI:1558126227
Name:EYONG&ETTA HEALTHCARE
Entity type:Organization
Organization Name:EYONG&ETTA HEALTHCARE
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:
Authorized Official - First Name:ADOLF
Authorized Official - Middle Name:
Authorized Official - Last Name:OBEN
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:240-758-2263
Mailing Address - Street 1:PO BOX 361597
Mailing Address - Street 2:
Mailing Address - City:COLUMBUS
Mailing Address - State:OH
Mailing Address - Zip Code:43236-1597
Mailing Address - Country:US
Mailing Address - Phone:240-758-2263
Mailing Address - Fax:124-084-7906
Practice Address - Street 1:5397 RAVINE BLUFF CT
Practice Address - Street 2:
Practice Address - City:COLUMBUS
Practice Address - State:OH
Practice Address - Zip Code:43231-3156
Practice Address - Country:US
Practice Address - Phone:240-758-2263
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2024-02-20
Last Update Date:2024-02-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes376J00000XNursing Service Related ProvidersHomemakerGroup - Single Specialty