Provider Demographics
NPI:1952385320
Name:FRIENDSHIP VILLAGE OF COLUMBUS
Entity Type:Organization
Organization Name:FRIENDSHIP VILLAGE OF COLUMBUS
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:ADMINISTRATOR
Authorized Official - Prefix:MS
Authorized Official - First Name:AMANDA
Authorized Official - Middle Name:
Authorized Official - Last Name:TRZCINSKI
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:614-890-8282
Mailing Address - Street 1:5800 FOREST HILLS BLVD
Mailing Address - Street 2:
Mailing Address - City:COLUMBUS
Mailing Address - State:OH
Mailing Address - Zip Code:43231-6916
Mailing Address - Country:US
Mailing Address - Phone:614-890-8282
Mailing Address - Fax:614-891-6556
Practice Address - Street 1:5800 FOREST HILLS BLVD
Practice Address - Street 2:
Practice Address - City:COLUMBUS
Practice Address - State:OH
Practice Address - Zip Code:43231-6916
Practice Address - Country:US
Practice Address - Phone:614-890-8282
Practice Address - Fax:614-891-6556
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2005-11-30
Last Update Date:2020-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OH2675310400000X
OH2835313M00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Not Answered310400000XNursing & Custodial Care FacilitiesAssisted Living Facility
Not Answered313M00000XNursing & Custodial Care FacilitiesNursing Facility/Intermediate Care Facility
Provider Identifiers
StateIdentifier IDID TypeIssuer
OH0383428Medicaid
OH0383428Medicaid