Provider Demographics
NPI:1205823770
Name:SCIOTO RETIREMENT COMMUNITY INC
Entity Type:Organization
Organization Name:SCIOTO RETIREMENT COMMUNITY INC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:A/R DIRECTOR
Authorized Official - Prefix:
Authorized Official - First Name:JANA
Authorized Official - Middle Name:
Authorized Official - Last Name:SMITH
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:937-277-0505
Mailing Address - Street 1:433 OBETZ RD
Mailing Address - Street 2:
Mailing Address - City:COLUMBUS
Mailing Address - State:OH
Mailing Address - Zip Code:43207-4098
Mailing Address - Country:US
Mailing Address - Phone:
Mailing Address - Fax:
Practice Address - Street 1:433 OBETZ RD
Practice Address - Street 2:
Practice Address - City:COLUMBUS
Practice Address - State:OH
Practice Address - Zip Code:43207-4098
Practice Address - Country:US
Practice Address - Phone:614-491-2000
Practice Address - Fax:614-295-1414
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2005-09-30
Last Update Date:2011-11-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OH2378R310400000X
OH2378N314000000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes314000000XNursing & Custodial Care FacilitiesSkilled Nursing Facility
No310400000XNursing & Custodial Care FacilitiesAssisted Living Facility
Provider Identifiers
StateIdentifier IDID TypeIssuer
OH2377306Medicaid
OH366259Medicare ID - Type Unspecified