Provider Demographics
NPI:1962550129
Name:BUCKEYE HEALTH AGENCY, LLC
Entity type:Organization
Organization Name:BUCKEYE HEALTH AGENCY, LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:
Authorized Official - First Name:BERNARD
Authorized Official - Middle Name:Y
Authorized Official - Last Name:KONADU
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:614-899-2478
Mailing Address - Street 1:2700 E DUBLIN GRANVILLE RD
Mailing Address - Street 2:200
Mailing Address - City:COLUMBUS
Mailing Address - State:OH
Mailing Address - Zip Code:43231-4094
Mailing Address - Country:US
Mailing Address - Phone:614-899-2478
Mailing Address - Fax:614-899-2479
Practice Address - Street 1:2700 E DUBLIN GRANVILLE RD
Practice Address - Street 2:200
Practice Address - City:COLUMBUS
Practice Address - State:OH
Practice Address - Zip Code:43231-4094
Practice Address - Country:US
Practice Address - Phone:614-899-2478
Practice Address - Fax:614-899-2479
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-01-06
Last Update Date:2013-08-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OH251E00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes251E00000XAgenciesHome Health