1033133665 NPI number — OHIO LIVING HOLDINGS

Table of Contents

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1033133665 NPI number — OHIO LIVING HOLDINGS

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
OHIO LIVING HOLDINGS
Provider Last Name:
Provider First Name:
Provider Middle Name:
Provider Name Prefix Text:
Provider Name Suffix Text:
Provider Credential Text:
Provider Gender Code:

Provider's Other Name Information

Provider Other Organization Name:
Provider Other Organization Name Type Code:
6
Provider Other Last Name:
Provider Other First Name:
Provider Other Middle Name:
Provider Other Name Prefix Text:
Provider Other Name Suffix Text:
Provider Other Credential Text:
Provider Other Last Name Type Code:

NPI Number Information

NPI Number:
1033133665
Entity Type Code:
Organization
Replacement NPI:
Last Update Date:
06/28/2024
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
9200 WORTHINGTON RD STE 300
Provider Second Line Business Mailing Address:
Provider Business Mailing Address City Name:
WESTERVILLE
Provider Business Mailing Address State Name:
OH
Provider Business Mailing Address Postal Code:
43082-7240
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
614-888-7800
Provider Business Mailing Address Fax Number:
614-888-6864

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
1701 LLANFAIR AVE STE 101
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
CINCINNATI
Provider Business Practice Location Address State Name:
OH
Provider Business Practice Location Address Postal Code:
45224-2972
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
513-681-4230
Provider Business Practice Location Address Fax Number:
513-782-8306
Provider Enumeration Date:
07/27/2006

Additional Information

Authorized Official

Authorized Official Last Name:
GUMINA
Authorized Official First Name:
LAURENCE
Authorized Official Middle Name:
C
Authorized Official Title or Position:
CEO
Authorized Official Telephone Number:
614-888-7800

Provider Taxonomy Codes

  • Taxonomy code: 251E00000X , registered in the state of OH ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

Other Provider's Identifiers (legacy, non-NPI)

  • Identifier: 0697054 , issued by the state of ( OH ) . This identifiers is of the category "MEDICAID".




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