Provider Demographics
NPI:1972196376
Name:SIMPLY INDEPENDENT LLC
Entity Type:Organization
Organization Name:SIMPLY INDEPENDENT LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:
Authorized Official - First Name:VICTOIRE
Authorized Official - Middle Name:
Authorized Official - Last Name:FIFE
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:614-477-6515
Mailing Address - Street 1:4581 DUNGANNON DR
Mailing Address - Street 2:
Mailing Address - City:GROVE CITY
Mailing Address - State:OH
Mailing Address - Zip Code:43123-8469
Mailing Address - Country:US
Mailing Address - Phone:614-477-6515
Mailing Address - Fax:
Practice Address - Street 1:3262 HENDERSON RD STE B
Practice Address - Street 2:
Practice Address - City:COLUMBUS
Practice Address - State:OH
Practice Address - Zip Code:43220-4393
Practice Address - Country:US
Practice Address - Phone:614-477-6515
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2021-02-17
Last Update Date:2021-02-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes374U00000XNursing Service Related ProvidersHome Health AideGroup - Single Specialty
No251C00000XAgenciesDay Training, Developmentally Disabled Services
Provider Identifiers
StateIdentifier IDID TypeIssuer
OH0182191Medicaid