Provider Demographics
NPI:1508322546
Name:PEREGRINE HEALTH SERVICES OF COLUMBUS LLC
Entity Type:Organization
Organization Name:PEREGRINE HEALTH SERVICES OF COLUMBUS LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:CFO
Authorized Official - Prefix:
Authorized Official - First Name:TIMOTHY
Authorized Official - Middle Name:DALE
Authorized Official - Last Name:PATTON
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:614-459-2656
Mailing Address - Street 1:1661 OLD HENDERSON RD
Mailing Address - Street 2:
Mailing Address - City:COLUMBUS
Mailing Address - State:OH
Mailing Address - Zip Code:43220-3644
Mailing Address - Country:US
Mailing Address - Phone:614-459-2656
Mailing Address - Fax:
Practice Address - Street 1:935 N CASSADY AVE
Practice Address - Street 2:
Practice Address - City:COLUMBUS
Practice Address - State:OH
Practice Address - Zip Code:43219-2283
Practice Address - Country:US
Practice Address - Phone:614-252-4987
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2019-02-14
Last Update Date:2019-02-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes310400000XNursing & Custodial Care FacilitiesAssisted Living Facility