Provider Demographics
NPI:1992095632
Name:LOYALTAY CARE PROVIDER LLC
Entity type:Organization
Organization Name:LOYALTAY CARE PROVIDER LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:CEO
Authorized Official - Prefix:
Authorized Official - First Name:OUSMANE
Authorized Official - Middle Name:
Authorized Official - Last Name:CAMARA
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:614-843-0881
Mailing Address - Street 1:4594 NORTHTOWNE BLVD G14
Mailing Address - Street 2:
Mailing Address - City:COLUMBUS
Mailing Address - State:OH
Mailing Address - Zip Code:43229
Mailing Address - Country:US
Mailing Address - Phone:614-843-0881
Mailing Address - Fax:
Practice Address - Street 1:4594 NORTHTOWNE BLVD G14
Practice Address - Street 2:
Practice Address - City:COLUMBUS
Practice Address - State:OH
Practice Address - Zip Code:43229
Practice Address - Country:US
Practice Address - Phone:614-843-0881
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2011-04-14
Last Update Date:2011-04-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OH3063124251E00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes251E00000XAgenciesHome Health