Provider Demographics
NPI:1992278402
Name:SANTIA NURSING CARE AND SUPPORTED LIVING
Entity type:Organization
Organization Name:SANTIA NURSING CARE AND SUPPORTED LIVING
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:MR
Authorized Official - First Name:MOHAMED
Authorized Official - Middle Name:
Authorized Official - Last Name:FOFANAH
Authorized Official - Suffix:
Authorized Official - Credentials:MPH
Authorized Official - Phone:614-929-1931
Mailing Address - Street 1:4186 BRACKENWOOD TRL
Mailing Address - Street 2:
Mailing Address - City:COLUMBUS
Mailing Address - State:OH
Mailing Address - Zip Code:43228-8440
Mailing Address - Country:US
Mailing Address - Phone:614-929-1931
Mailing Address - Fax:
Practice Address - Street 1:4186 BRACKENWOOD TRL
Practice Address - Street 2:
Practice Address - City:COLUMBUS
Practice Address - State:OH
Practice Address - Zip Code:43228-8440
Practice Address - Country:US
Practice Address - Phone:614-929-1931
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2019-01-08
Last Update Date:2019-01-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes251E00000XAgenciesHome Health