Provider Demographics
NPI:1447884077
Name:FIRST CARE INTEGRATED HEALTH LLC
Entity type:Organization
Organization Name:FIRST CARE INTEGRATED HEALTH LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:NP/CEO
Authorized Official - Prefix:
Authorized Official - First Name:FANTA
Authorized Official - Middle Name:
Authorized Official - Last Name:BERETAY
Authorized Official - Suffix:
Authorized Official - Credentials:CNP
Authorized Official - Phone:614-226-5622
Mailing Address - Street 1:6167 BUCKEYE PKWY
Mailing Address - Street 2:
Mailing Address - City:GROVE CITY
Mailing Address - State:OH
Mailing Address - Zip Code:43123-8387
Mailing Address - Country:US
Mailing Address - Phone:614-493-9884
Mailing Address - Fax:
Practice Address - Street 1:5150 E MAIN ST STE 102
Practice Address - Street 2:
Practice Address - City:COLUMBUS
Practice Address - State:OH
Practice Address - Zip Code:43213-2441
Practice Address - Country:US
Practice Address - Phone:614-226-5622
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2020-02-21
Last Update Date:2023-06-30
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes363LP0808XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerPsychiatric/Mental HealthGroup - Multi-Specialty
No207QA0401XAllopathic & Osteopathic PhysiciansFamily MedicineAddiction MedicineGroup - Multi-Specialty
No363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamilyGroup - Multi-Specialty
No363LP2300XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerPrimary CareGroup - Multi-Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
OH0227206Medicaid