Provider Demographics
NPI:1972291581
Name:UMBRELLA SUPPORTIVE LIVING LLC
Entity Type:Organization
Organization Name:UMBRELLA SUPPORTIVE LIVING LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:CEO
Authorized Official - Prefix:
Authorized Official - First Name:DAVID
Authorized Official - Middle Name:W
Authorized Official - Last Name:GRAY
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:888-295-3954
Mailing Address - Street 1:5 TRIANGLE PARK DR STE 501
Mailing Address - Street 2:
Mailing Address - City:CINCINNATI
Mailing Address - State:OH
Mailing Address - Zip Code:45246-3402
Mailing Address - Country:US
Mailing Address - Phone:888-295-3954
Mailing Address - Fax:513-672-9589
Practice Address - Street 1:5 TRIANGLE PARK DR STE 501
Practice Address - Street 2:
Practice Address - City:CINCINNATI
Practice Address - State:OH
Practice Address - Zip Code:45246-3402
Practice Address - Country:US
Practice Address - Phone:513-237-5764
Practice Address - Fax:513-672-9589
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2023-05-01
Last Update Date:2023-05-01
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes253Z00000XAgenciesIn Home Supportive Care