Provider Demographics
NPI:1417165846
Name:FRANKLIN COUNTY RESIDENTIAL SERVICES, INC.
Entity Type:Organization
Organization Name:FRANKLIN COUNTY RESIDENTIAL SERVICES, INC.
Other - Org Name:KIMBERLY WOODS HOME
Other - Org Type:Doing Business As
Authorized Official - Title/Position:EXECUTIVE DIRECTOR
Authorized Official - Prefix:MR
Authorized Official - First Name:ED
Authorized Official - Middle Name:
Authorized Official - Last Name:HARPER
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:614-844-3800
Mailing Address - Street 1:1021 CHECKREIN AVE
Mailing Address - Street 2:
Mailing Address - City:COLUMBUS
Mailing Address - State:OH
Mailing Address - Zip Code:43229-1106
Mailing Address - Country:US
Mailing Address - Phone:614-844-3800
Mailing Address - Fax:614-844-5913
Practice Address - Street 1:2434 KIMBERLY WOODS DR
Practice Address - Street 2:
Practice Address - City:COLUMBUS
Practice Address - State:OH
Practice Address - Zip Code:43232-4290
Practice Address - Country:US
Practice Address - Phone:614-844-3800
Practice Address - Fax:614-844-5913
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-05-18
Last Update Date:2020-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OH2512507315P00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes315P00000XNursing & Custodial Care FacilitiesIntermediate Care Facility, Intellectual Disabilities
Provider Identifiers
StateIdentifier IDID TypeIssuer
OH0675032Medicaid
OH36-G270Medicare ID - Type Unspecified