1972609030 NPI number — NATIONAL CHURCH RESIDENCES AT HOME HOSPICE, CENTRAL OHIO

Table of content: (NPI 1972609030)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1972609030 NPI number — NATIONAL CHURCH RESIDENCES AT HOME HOSPICE, CENTRAL OHIO

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
NATIONAL CHURCH RESIDENCES AT HOME HOSPICE, CENTRAL OHIO
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:
1972609030
Entity Type Code:
Organization
Replacement NPI:
Last Update Date:
09/01/2021
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
2335 N BANK DR
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:
43220-5423
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
614-451-2151
Provider Business Mailing Address Fax Number:
614-442-7040

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
2245 N BANK DR
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:
43220
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
614-457-6950
Provider Business Practice Location Address Fax Number:
614-457-6951
Provider Enumeration Date:
09/16/2006

Additional Information

Authorized Official

Authorized Official Last Name:
DIMICKELE
Authorized Official First Name:
SUSAN
Authorized Official Middle Name:
Authorized Official Title or Position:
PRESIDENT
Authorized Official Telephone Number:
614-451-2151

Provider Taxonomy Codes

  • Taxonomy code: 251G00000X ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

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

  • Identifier: 2814762 , issued by the state of ( OH ) . This identifiers is of the category "MEDICAID".




Copyright © 2007-2025 www.npivalidator.com