Provider Demographics
NPI:1003676123
Name:COLUMBUS SENIOR LIVING LLC
Entity Type:Organization
Organization Name:COLUMBUS SENIOR LIVING LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:DIRECTOR OF BUSINESS OFFICE AND WAI
Authorized Official - Prefix:
Authorized Official - First Name:KRIS
Authorized Official - Middle Name:
Authorized Official - Last Name:PETERS
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:260-452-4896
Mailing Address - Street 1:4300 W GOELLER BLVD
Mailing Address - Street 2:
Mailing Address - City:COLUMBUS
Mailing Address - State:IN
Mailing Address - Zip Code:47201-8050
Mailing Address - Country:US
Mailing Address - Phone:260-452-4896
Mailing Address - Fax:
Practice Address - Street 1:4300 W GOELLER BLVD
Practice Address - Street 2:
Practice Address - City:COLUMBUS
Practice Address - State:IN
Practice Address - Zip Code:47201-8050
Practice Address - Country:US
Practice Address - Phone:260-452-4896
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2024-03-19
Last Update Date:2024-03-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes310400000XNursing & Custodial Care FacilitiesAssisted Living Facility