Provider Demographics
NPI:1336306026
Name:CENTRAL OHIO NURSING AGENCY, LLC
Entity Type:Organization
Organization Name:CENTRAL OHIO NURSING AGENCY, LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:CEO/ PRESIDENT
Authorized Official - Prefix:MISS
Authorized Official - First Name:SOPHIA
Authorized Official - Middle Name:LOREN
Authorized Official - Last Name:BERRY STVICTOR
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:614-598-6396
Mailing Address - Street 1:4770 INDIANOLA AVE
Mailing Address - Street 2:SUITE 270
Mailing Address - City:COLUMBUS
Mailing Address - State:OH
Mailing Address - Zip Code:43214-1862
Mailing Address - Country:US
Mailing Address - Phone:614-598-6396
Mailing Address - Fax:614-781-0208
Practice Address - Street 1:4770 INDIANOLA AVE
Practice Address - Street 2:SUITE 270
Practice Address - City:COLUMBUS
Practice Address - State:OH
Practice Address - Zip Code:43214-1862
Practice Address - Country:US
Practice Address - Phone:614-598-6396
Practice Address - Fax:614-781-0208
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2008-05-20
Last Update Date:2008-05-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OH251J00000X251J00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes251J00000XAgenciesNursing Care