1790235588 NPI number — AMERICAN SENIOR CARE CENTER LLC

Table of content: (NPI 1790235588)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1790235588 NPI number — AMERICAN SENIOR CARE CENTER LLC

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
AMERICAN SENIOR CARE CENTER 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:
1790235588
Entity Type Code:
Organization
Replacement NPI:
Last Update Date:
10/05/2016
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
3105 W BROAD STREET
Provider Second Line Business Mailing Address:
SUITE 2
Provider Business Mailing Address City Name:
COLUMBUS
Provider Business Mailing Address State Name:
OH
Provider Business Mailing Address Postal Code:
43204
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
614-867-5607
Provider Business Mailing Address Fax Number:
614-417-5095

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
3105 W BROAD STREET
Provider Second Line Business Practice Location Address:
SUITE 2
Provider Business Practice Location Address City Name:
COLUMBUS
Provider Business Practice Location Address State Name:
OH
Provider Business Practice Location Address Postal Code:
43204
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
614-867-5607
Provider Business Practice Location Address Fax Number:
614-417-5095
Provider Enumeration Date:
10/05/2016

Additional Information

Authorized Official

Authorized Official Last Name:
MOHAMED
Authorized Official First Name:
ABUBAKAR
Authorized Official Middle Name:
Authorized Official Title or Position:
ADMINISTRATOR
Authorized Official Telephone Number:
614-843-2788

Provider Taxonomy Codes

  • Taxonomy code: 251E00000X , with the licence number:  0174783 , 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: 0174783 , issued by the state of ( OH ) . This identifiers is of the category "MEDICAID".
  • Identifier: 2570749 . This is a "DODD CONTRACT NUMBER" identifier , issued by the state of ( OH ) . This identifiers is of the category "OTHER".




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