Provider Demographics
NPI:1821789264
Name:360 HEALTHCARE LLC
Entity Type:Organization
Organization Name:360 HEALTHCARE LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:DR
Authorized Official - First Name:KYANNA
Authorized Official - Middle Name:
Authorized Official - Last Name:WILMER
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:614-946-6500
Mailing Address - Street 1:5272 SABINE HALL
Mailing Address - Street 2:
Mailing Address - City:NEW ALBANY
Mailing Address - State:OH
Mailing Address - Zip Code:43054-8719
Mailing Address - Country:US
Mailing Address - Phone:614-946-6500
Mailing Address - Fax:
Practice Address - Street 1:5272 SABINE HALL
Practice Address - Street 2:
Practice Address - City:NEW ALBANY
Practice Address - State:OH
Practice Address - Zip Code:43054-8719
Practice Address - Country:US
Practice Address - Phone:614-946-6500
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2023-05-17
Last Update Date:2023-06-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes251S00000XAgenciesCommunity/Behavioral Health
Yes251E00000XAgenciesHome Health
No322D00000XResidential Treatment FacilitiesResidential Treatment Facility, Emotionally Disturbed Children