Provider Demographics
NPI:1689606899
Name:WEXNER HERITAGE VILLAGE
Entity Type:Organization
Organization Name:WEXNER HERITAGE VILLAGE
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:SPEECH PATHOLOGIST
Authorized Official - Prefix:
Authorized Official - First Name:YVONNE
Authorized Official - Middle Name:
Authorized Official - Last Name:KOVAC
Authorized Official - Suffix:
Authorized Official - Credentials:CCC-SLP
Authorized Official - Phone:614-559-0260
Mailing Address - Street 1:2916 ESSINGTON DR
Mailing Address - Street 2:
Mailing Address - City:DUBLIN
Mailing Address - State:OH
Mailing Address - Zip Code:43017-1763
Mailing Address - Country:US
Mailing Address - Phone:614-798-1109
Mailing Address - Fax:
Practice Address - Street 1:1151 COLLEGE AVE
Practice Address - Street 2:
Practice Address - City:COLUMBUS
Practice Address - State:OH
Practice Address - Zip Code:43209-2827
Practice Address - Country:US
Practice Address - Phone:614-559-0260
Practice Address - Fax:614-338-2399
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-07-07
Last Update Date:2020-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OHSLP-4222314000000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes314000000XNursing & Custodial Care FacilitiesSkilled Nursing Facility