Provider Demographics
NPI:1538442876
Name:ERNESTINE HEALTHCARE
Entity type:Organization
Organization Name:ERNESTINE HEALTHCARE
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:RN
Authorized Official - Prefix:MS
Authorized Official - First Name:ENESTINE
Authorized Official - Middle Name:AZENKENG
Authorized Official - Last Name:TASONG
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:614-446-6016
Mailing Address - Street 1:47 JORDANA DR
Mailing Address - Street 2:
Mailing Address - City:GAHANNA
Mailing Address - State:OH
Mailing Address - Zip Code:43230-4406
Mailing Address - Country:US
Mailing Address - Phone:614-446-6016
Mailing Address - Fax:
Practice Address - Street 1:47 JORDANA DR
Practice Address - Street 2:
Practice Address - City:GAHANNA
Practice Address - State:OH
Practice Address - Zip Code:43230-4406
Practice Address - Country:US
Practice Address - Phone:614-446-6016
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2011-09-22
Last Update Date:2011-09-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OH342944251B00000X, 251F00000X, 251G00000X, 251K00000X, 251S00000X, 253Z00000X, 261QM0855X, 320800000X, 251E00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes251E00000XAgenciesHome Health
No251B00000XAgenciesCase Management
No251F00000XAgenciesHome Infusion
No251G00000XAgenciesHospice Care, Community Based
No251K00000XAgenciesPublic Health or Welfare
No251S00000XAgenciesCommunity/Behavioral Health
No253Z00000XAgenciesIn Home Supportive Care
No261QM0855XAmbulatory Health Care FacilitiesClinic/CenterAdolescent and Children Mental Health
No320800000XResidential Treatment FacilitiesCommunity Based Residential Treatment Facility, Mental Illness