1104164276 NPI number — LUTHERAN SOCIAL SERVICES OF CENTRAL OHIO HOME CARE LLC

Table of content: (NPI 1104164276)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1104164276 NPI number — LUTHERAN SOCIAL SERVICES OF CENTRAL OHIO HOME CARE LLC

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
LUTHERAN SOCIAL SERVICES OF CENTRAL OHIO HOME CARE LLC
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:
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:
1104164276
Entity Type Code:
Organization
Replacement NPI:
Last Update Date:
01/24/2013
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
500 W WILSON BRIDGE RD
Provider Second Line Business Mailing Address:
STE 245
Provider Business Mailing Address City Name:
WORTHINGTON
Provider Business Mailing Address State Name:
OH
Provider Business Mailing Address Postal Code:
43085-2238
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
614-431-0599
Provider Business Mailing Address Fax Number:
614-431-0596

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
500 W WILSON BRIDGE RD
Provider Second Line Business Practice Location Address:
STE 245
Provider Business Practice Location Address City Name:
WORTHINGTON
Provider Business Practice Location Address State Name:
OH
Provider Business Practice Location Address Postal Code:
43085-2238
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
614-431-0599
Provider Business Practice Location Address Fax Number:
614-431-0596
Provider Enumeration Date:
01/24/2013

Additional Information

Authorized Official

Authorized Official Last Name:
ITTIKRAICHAREON
Authorized Official First Name:
DEBRA
Authorized Official Middle Name:
A
Authorized Official Title or Position:
ASST. ADMIN
Authorized Official Telephone Number:
614-431-0599

Provider Taxonomy Codes

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

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

  • Identifier: 280390739 , issued by the state of ( OH ) . This identifiers is of the category "MEDICAID".




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