Provider Demographics
NPI:1992404297
Name:EKOBEMELLE SUBE, FNU
Entity type:Individual
Prefix:
First Name:FNU
Middle Name:
Last Name:EKOBEMELLE SUBE
Suffix:
Gender:M
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:4055 LEATHER STOCKING TRL
Mailing Address - Street 2:
Mailing Address - City:COLUMBUS
Mailing Address - State:OH
Mailing Address - Zip Code:43230-1528
Mailing Address - Country:US
Mailing Address - Phone:614-592-6423
Mailing Address - Fax:
Practice Address - Street 1:4055 LEATHER STOCKING TRL
Practice Address - Street 2:
Practice Address - City:COLUMBUS
Practice Address - State:OH
Practice Address - Zip Code:43230-1528
Practice Address - Country:US
Practice Address - Phone:614-592-6423
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2023-02-27
Last Update Date:2023-02-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes374U00000XNursing Service Related ProvidersHome Health Aide
No251X00000XAgenciesSupports Brokerage
No347C00000XTransportation ServicesPrivate Vehicle
No3747P1801XNursing Service Related ProvidersTechnicianPersonal Care Attendant
No376J00000XNursing Service Related ProvidersHomemaker
No376K00000XNursing Service Related ProvidersNurse's Aide