Provider Demographics
NPI:1134364847
Name:OHIO LIVING COMMUNITIES
Entity type:Organization
Organization Name:OHIO LIVING COMMUNITIES
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:CEO
Authorized Official - Prefix:
Authorized Official - First Name:LAURENCE
Authorized Official - Middle Name:C
Authorized Official - Last Name:GUMINA
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:614-888-7800
Mailing Address - Street 1:3820 E VINEYARD VILLAGE DR
Mailing Address - Street 2:
Mailing Address - City:PORT CLINTON
Mailing Address - State:OH
Mailing Address - Zip Code:43452-4117
Mailing Address - Country:US
Mailing Address - Phone:419-797-3100
Mailing Address - Fax:419-797-0050
Practice Address - Street 1:3820 E VINEYARD VILLAGE DR
Practice Address - Street 2:
Practice Address - City:PORT CLINTON
Practice Address - State:OH
Practice Address - Zip Code:43452-4117
Practice Address - Country:US
Practice Address - Phone:419-797-3100
Practice Address - Fax:419-797-0050
EIN:<UNAVAIL>
Is Organization Subpart?:Yes
Parent Organization LBN:OHIO LIVING
Parent Organization TIN:<UNAVAIL>
Enumeration Date:2008-12-09
Last Update Date:2019-01-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OH2365R310400000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes310400000XNursing & Custodial Care FacilitiesAssisted Living Facility
Provider Identifiers
StateIdentifier IDID TypeIssuer
OH2365ROtherRESIDENTIAL CARE FACILITY LICENSE NUMBER