Provider Demographics
NPI:1942376868
Name:HEALTHCARE VENTURES OF OHIO, LLC
Entity Type:Organization
Organization Name:HEALTHCARE VENTURES OF OHIO, LLC
Other - Org Name:AUTUMN COURT
Other - Org Type:Doing Business As
Authorized Official - Title/Position:CONTROLLER
Authorized Official - Prefix:
Authorized Official - First Name:OSCAR
Authorized Official - Middle Name:G
Authorized Official - Last Name:ALEMAN
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:614-459-2482
Mailing Address - Street 1:1661 OLD HENDERSON RD
Mailing Address - Street 2:
Mailing Address - City:COLUMBUS
Mailing Address - State:OH
Mailing Address - Zip Code:43220-3644
Mailing Address - Country:US
Mailing Address - Phone:614-459-2482
Mailing Address - Fax:614-459-2641
Practice Address - Street 1:1925 E 4TH ST
Practice Address - Street 2:
Practice Address - City:OTTAWA
Practice Address - State:OH
Practice Address - Zip Code:45875-1540
Practice Address - Country:US
Practice Address - Phone:419-523-4370
Practice Address - Fax:419-523-3591
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-11-24
Last Update Date:2008-09-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OH1543N314000000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes314000000XNursing & Custodial Care FacilitiesSkilled Nursing Facility
Provider Identifiers
StateIdentifier IDID TypeIssuer
OH2561357Medicaid
OH36-6217Medicare ID - Type UnspecifiedMEDICARE PROVIDER NUMBER