Provider Demographics
NPI:1972609238
Name:NATIONAL CHURCH RESIDENCES AT HOME, CENTRAL OHIO
Entity Type:Organization
Organization Name:NATIONAL CHURCH RESIDENCES AT HOME, CENTRAL OHIO
Other - Org Name:NATLCHRCHRES HOME AND COMMUNITY SERVICES CENTRAL OHIO HOME HEALTH
Other - Org Type:Doing Business As
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:
Authorized Official - First Name:SUSAN
Authorized Official - Middle Name:
Authorized Official - Last Name:DIMICKELE
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:614-451-2151
Mailing Address - Street 1:2335 N BANK DR
Mailing Address - Street 2:
Mailing Address - City:COLUMBUS
Mailing Address - State:OH
Mailing Address - Zip Code:43220-5423
Mailing Address - Country:US
Mailing Address - Phone:614-451-2151
Mailing Address - Fax:614-442-7040
Practice Address - Street 1:2245 N BANK DR
Practice Address - Street 2:
Practice Address - City:COLUMBUS
Practice Address - State:OH
Practice Address - Zip Code:43220
Practice Address - Country:US
Practice Address - Phone:614-457-6950
Practice Address - Fax:614-457-6951
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-09-15
Last Update Date:2021-09-01
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OH1574073251E00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes251E00000XAgenciesHome Health
Provider Identifiers
StateIdentifier IDID TypeIssuer
OH2704701Medicaid
OH2704701Medicaid