Provider Demographics
NPI:1508467853
Name:ULTIMATE CARE SUPPORTED LIVING LLC
Entity Type:Organization
Organization Name:ULTIMATE CARE SUPPORTED LIVING LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:MR
Authorized Official - First Name:SAMUEL
Authorized Official - Middle Name:
Authorized Official - Last Name:BRAIMA
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:614-868-3821
Mailing Address - Street 1:2020 BRICE RD STE 235
Mailing Address - Street 2:
Mailing Address - City:REYNOLDSBURG
Mailing Address - State:OH
Mailing Address - Zip Code:43068-3464
Mailing Address - Country:US
Mailing Address - Phone:614-868-3821
Mailing Address - Fax:
Practice Address - Street 1:5300 E MAIN ST STE 100
Practice Address - Street 2:
Practice Address - City:COLUMBUS
Practice Address - State:OH
Practice Address - Zip Code:43213-2580
Practice Address - Country:US
Practice Address - Phone:614-868-3821
Practice Address - Fax:614-868-3921
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2020-11-03
Last Update Date:2023-10-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes3104A0625XNursing & Custodial Care FacilitiesAssisted Living FacilityAssisted Living, Mental Illness
No3104A0630XNursing & Custodial Care FacilitiesAssisted Living FacilityAssisted Living, Behavioral Disturbances