Provider Demographics
NPI:1689139537
Name:ABSOLUTE-RICHARD SUPPORTIVE LIVING LLC
Entity Type:Organization
Organization Name:ABSOLUTE-RICHARD SUPPORTIVE LIVING LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:CEO
Authorized Official - Prefix:
Authorized Official - First Name:TAKANG
Authorized Official - Middle Name:N
Authorized Official - Last Name:ABUNAW
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:419-534-2371
Mailing Address - Street 1:5237 RENWYCK DR
Mailing Address - Street 2:
Mailing Address - City:TOLEDO
Mailing Address - State:OH
Mailing Address - Zip Code:43615-5996
Mailing Address - Country:US
Mailing Address - Phone:419-534-2371
Mailing Address - Fax:419-534-2392
Practice Address - Street 1:5237 RENWYCK DR
Practice Address - Street 2:
Practice Address - City:TOLEDO
Practice Address - State:OH
Practice Address - Zip Code:43615-5996
Practice Address - Country:US
Practice Address - Phone:419-534-2371
Practice Address - Fax:419-534-2392
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2019-02-05
Last Update Date:2019-02-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes343900000XTransportation ServicesNon-emergency Medical Transport (VAN)
No251C00000XAgenciesDay Training, Developmentally Disabled Services
No251E00000XAgenciesHome Health
No251J00000XAgenciesNursing Care
No251S00000XAgenciesCommunity/Behavioral Health
No253Z00000XAgenciesIn Home Supportive Care
No343800000XTransportation ServicesSecured Medical Transport (VAN)
No347C00000XTransportation ServicesPrivate Vehicle
No385H00000XRespite Care FacilityRespite Care
Provider Identifiers
StateIdentifier IDID TypeIssuer
OH2718456Medicaid