Provider Demographics
NPI:1649435926
Name:GOOD HANDS SUPPORTED LIVING, LTD.
Entity type:Organization
Organization Name:GOOD HANDS SUPPORTED LIVING, LTD.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:MR
Authorized Official - First Name:BRAHIM
Authorized Official - Middle Name:
Authorized Official - Last Name:DJAFI
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:614-899-7320
Mailing Address - Street 1:2491 E DUBLIN GRANVILLE RD
Mailing Address - Street 2:
Mailing Address - City:COLUMBUS
Mailing Address - State:OH
Mailing Address - Zip Code:43229-3521
Mailing Address - Country:US
Mailing Address - Phone:614-899-7320
Mailing Address - Fax:614-899-7326
Practice Address - Street 1:2491 E DUBLIN GRANVILLE RD
Practice Address - Street 2:
Practice Address - City:COLUMBUS
Practice Address - State:OH
Practice Address - Zip Code:43229-3521
Practice Address - Country:US
Practice Address - Phone:614-899-7320
Practice Address - Fax:614-899-7326
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2008-07-25
Last Update Date:2008-07-25
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OH2511455251C00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes251C00000XAgenciesDay Training, Developmentally Disabled Services
Provider Identifiers
StateIdentifier IDID TypeIssuer
OH2147000Medicaid