Provider Demographics
NPI:1700371911
Name:CENTRAL OHIO LIFE CARE CENTER LLC
Entity Type:Organization
Organization Name:CENTRAL OHIO LIFE CARE CENTER LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:C.E.O
Authorized Official - Prefix:
Authorized Official - First Name:ADEN
Authorized Official - Middle Name:J
Authorized Official - Last Name:FARAH
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:614-735-3165
Mailing Address - Street 1:1150 MORSE RD STE 110
Mailing Address - Street 2:
Mailing Address - City:COLUMBUS
Mailing Address - State:OH
Mailing Address - Zip Code:43229-6327
Mailing Address - Country:US
Mailing Address - Phone:614-735-3165
Mailing Address - Fax:614-396-6355
Practice Address - Street 1:1150 MORSE RD STE 110
Practice Address - Street 2:
Practice Address - City:COLUMBUS
Practice Address - State:OH
Practice Address - Zip Code:43229-6327
Practice Address - Country:US
Practice Address - Phone:614-735-3165
Practice Address - Fax:614-396-6355
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2018-06-29
Last Update Date:2021-12-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
ND251C00000X
251E00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes251E00000XAgenciesHome Health
No251C00000XAgenciesDay Training, Developmentally Disabled Services