Provider Demographics
NPI:1134822075
Name:TOTAL CARE CONNECT LLC
Entity type:Organization
Organization Name:TOTAL CARE CONNECT LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:CREDENTIALING
Authorized Official - Prefix:
Authorized Official - First Name:JAYVEER
Authorized Official - Middle Name:
Authorized Official - Last Name:SODIWAL
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:614-407-1614
Mailing Address - Street 1:2331 KEEP PL
Mailing Address - Street 2:
Mailing Address - City:COLUMBUS
Mailing Address - State:OH
Mailing Address - Zip Code:43204-4989
Mailing Address - Country:US
Mailing Address - Phone:614-407-1614
Mailing Address - Fax:
Practice Address - Street 1:2331 KEEP PL
Practice Address - Street 2:
Practice Address - City:COLUMBUS
Practice Address - State:OH
Practice Address - Zip Code:43204-4989
Practice Address - Country:US
Practice Address - Phone:614-407-1614
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2023-03-22
Last Update Date:2023-10-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes261QP2300XAmbulatory Health Care FacilitiesClinic/CenterPrimary CareGroup - Single Specialty
No363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamilyGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
OH0021705Medicaid