Provider Demographics
NPI:1063476802
Name:OHIO LIVING SARAH MOORE
Entity Type:Organization
Organization Name:OHIO LIVING SARAH MOORE
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:CHIEF FINANCIAL OFFICER
Authorized Official - Prefix:
Authorized Official - First Name:ROBERT
Authorized Official - Middle Name:B
Authorized Official - Last Name:STILLMAN
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:614-888-7800
Mailing Address - Street 1:9200 WORTHINGTON RD STE 300
Mailing Address - Street 2:
Mailing Address - City:WESTERVILLE
Mailing Address - State:OH
Mailing Address - Zip Code:43082-7240
Mailing Address - Country:US
Mailing Address - Phone:614-888-7800
Mailing Address - Fax:614-888-6864
Practice Address - Street 1:26 N UNION ST
Practice Address - Street 2:
Practice Address - City:DELAWARE
Practice Address - State:OH
Practice Address - Zip Code:43015-1922
Practice Address - Country:US
Practice Address - Phone:740-362-9641
Practice Address - Fax:740-362-7039
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-04-17
Last Update Date:2022-08-26
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes310400000XNursing & Custodial Care FacilitiesAssisted Living Facility
Yes314000000XNursing & Custodial Care FacilitiesSkilled Nursing Facility
Provider Identifiers
StateIdentifier IDID TypeIssuer
OH2101808Medicaid
OH366310Medicare Oscar/Certification