1275529273 NPI number — OHIO LIVING COMMUNITIES

Table of content: (NPI 1275529273)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1275529273 NPI number — OHIO LIVING COMMUNITIES

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
OHIO LIVING COMMUNITIES
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:
1275529273
Entity Type Code:
Organization
Replacement NPI:
Last Update Date:
01/27/2019
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
1001 KINGSMILL PKWY
Provider Second Line Business Mailing Address:
Provider Business Mailing Address City Name:
COLUMBUS
Provider Business Mailing Address State Name:
OH
Provider Business Mailing Address Postal Code:
43229-1129
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:
717 NEIL AVE
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
COLUMBUS
Provider Business Practice Location Address State Name:
OH
Provider Business Practice Location Address Postal Code:
43215-1609
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
614-228-8888
Provider Business Practice Location Address Fax Number:
614-228-8898
Provider Enumeration Date:
09/25/2005

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: 314000000X , with the licence number:  4793 , 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: 0034297 , issued by the state of ( OH ) . This identifiers is of the category "MEDICAID".
  • Identifier: 000000216393 . This is a "ANTHEM BC/BS" identifier , issued by the state of ( OH ) . This identifiers is of the category "OTHER".




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