Provider Demographics
NPI:1790235588
Name:AMERICAN SENIOR CARE CENTER LLC
Entity Type:Organization
Organization Name:AMERICAN SENIOR CARE CENTER LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:ADMINISTRATOR
Authorized Official - Prefix:MR
Authorized Official - First Name:ABUBAKAR
Authorized Official - Middle Name:
Authorized Official - Last Name:MOHAMED
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:614-843-2788
Mailing Address - Street 1:3105 W BROAD STREET
Mailing Address - Street 2:SUITE 2
Mailing Address - City:COLUMBUS
Mailing Address - State:OH
Mailing Address - Zip Code:43204
Mailing Address - Country:US
Mailing Address - Phone:614-867-5607
Mailing Address - Fax:614-417-5095
Practice Address - Street 1:3105 W BROAD STREET
Practice Address - Street 2:SUITE 2
Practice Address - City:COLUMBUS
Practice Address - State:OH
Practice Address - Zip Code:43204
Practice Address - Country:US
Practice Address - Phone:614-867-5607
Practice Address - Fax:614-417-5095
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2016-10-05
Last Update Date:2016-10-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OH0174783251E00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes251E00000XAgenciesHome Health
Provider Identifiers
StateIdentifier IDID TypeIssuer
OH0174783Medicaid
OH2570749OtherDODD CONTRACT NUMBER