Provider Demographics
NPI:1942091624
Name:AMOUSSOU, EPHRAIM MANASSE
Entity type:Individual
Prefix:
First Name:EPHRAIM MANASSE
Middle Name:
Last Name:AMOUSSOU
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 1:2625 GREENWAY ST
Mailing Address - Street 2:
Mailing Address - City:TOLEDO
Mailing Address - State:OH
Mailing Address - Zip Code:43607-1349
Mailing Address - Country:US
Mailing Address - Phone:220-219-0872
Mailing Address - Fax:
Practice Address - Street 1:2625 GREENWAY ST
Practice Address - Street 2:
Practice Address - City:TOLEDO
Practice Address - State:OH
Practice Address - Zip Code:43607-1349
Practice Address - Country:US
Practice Address - Phone:220-219-0872
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2025-05-13
Last Update Date:2025-05-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes376J00000XNursing Service Related ProvidersHomemaker