Provider Demographics
NPI:1821063975
Name:OHIO LIVING QUAKER HEIGHTS
Entity Type:Organization
Organization Name:OHIO LIVING QUAKER HEIGHTS
Other - Org Name:OHIO LIVING QUAKER HEIGHTS
Other - Org Type:Doing Business As
Authorized Official - Title/Position:CORPORATE MANAGER OF MANAGED CARE
Authorized Official - Prefix:
Authorized Official - First Name:JOHN
Authorized Official - Middle Name:WAYNE
Authorized Official - Last Name:PERKINS
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:614-888-7800
Mailing Address - Street 1:9200 WORTHINGTON RD STE 300
Mailing Address - Street 2:
Mailing Address - City:WESTERVILLE
Mailing Address - State:OH
Mailing Address - Zip Code:43082-7240
Mailing Address - Country:US
Mailing Address - Phone:614-888-7800
Mailing Address - Fax:148-886-6864
Practice Address - Street 1:514 HIGH ST
Practice Address - Street 2:
Practice Address - City:WAYNESVILLE
Practice Address - State:OH
Practice Address - Zip Code:45068-9784
Practice Address - Country:US
Practice Address - Phone:937-897-6050
Practice Address - Fax:937-897-6052
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-02-22
Last Update Date:2021-12-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes314000000XNursing & Custodial Care FacilitiesSkilled Nursing Facility
Provider Identifiers
StateIdentifier IDID TypeIssuer
OH0194196Medicaid
OH1511NOtherOHIO DEPARTMENT OF HEALTH
OH0581860001Medicare NSC