Provider Demographics
NPI:1841431475
Name:SENIOR CARE ADVANTAGE LLC
Entity Type:Organization
Organization Name:SENIOR CARE ADVANTAGE LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:DIRECTOR
Authorized Official - Prefix:DR
Authorized Official - First Name:GAVIN
Authorized Official - Middle Name:
Authorized Official - Last Name:BAUMGARDNER
Authorized Official - Suffix:
Authorized Official - Credentials:DO
Authorized Official - Phone:614-595-1055
Mailing Address - Street 1:PO BOX 920
Mailing Address - Street 2:SUITE 321
Mailing Address - City:DUBLIN
Mailing Address - State:OH
Mailing Address - Zip Code:43017-6920
Mailing Address - Country:US
Mailing Address - Phone:614-595-1055
Mailing Address - Fax:614-923-7813
Practice Address - Street 1:7652 SAWMILL RD
Practice Address - Street 2:SUITE 321
Practice Address - City:DUBLIN
Practice Address - State:OH
Practice Address - Zip Code:43016-9296
Practice Address - Country:US
Practice Address - Phone:614-595-1055
Practice Address - Fax:614-923-7813
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2009-03-11
Last Update Date:2014-09-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207R00000XAllopathic & Osteopathic PhysiciansInternal MedicineGroup - Multi-Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
OH2958232Medicaid
OH9383381Medicare PIN