Provider Demographics
NPI:1639539406
Name:BUCKEYE DIVERSITY LLC
Entity Type:Organization
Organization Name:BUCKEYE DIVERSITY LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:
Authorized Official - First Name:GEGORY
Authorized Official - Middle Name:
Authorized Official - Last Name:BUCHER
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:513-544-8098
Mailing Address - Street 1:3923 ORCHARD LN
Mailing Address - Street 2:
Mailing Address - City:GROVE CITY
Mailing Address - State:OH
Mailing Address - Zip Code:43123-2731
Mailing Address - Country:US
Mailing Address - Phone:614-461-3050
Mailing Address - Fax:301-718-0604
Practice Address - Street 1:3923 ORCHARD LN
Practice Address - Street 2:
Practice Address - City:GROVE CITY
Practice Address - State:OH
Practice Address - Zip Code:43123-2731
Practice Address - Country:US
Practice Address - Phone:614-461-3050
Practice Address - Fax:301-718-0604
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2016-03-07
Last Update Date:2020-05-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes253Z00000XAgenciesIn Home Supportive Care
No251C00000XAgenciesDay Training, Developmentally Disabled Services
No251J00000XAgenciesNursing Care
No251S00000XAgenciesCommunity/Behavioral Health
Provider Identifiers
StateIdentifier IDID TypeIssuer
OH3152207Medicaid