Provider Demographics
NPI:1952924136
Name:VIVERA SENIOR LIVING OF COLUMBUS, LLC
Entity Type:Organization
Organization Name:VIVERA SENIOR LIVING OF COLUMBUS, LLC
Other - Org Name:VIVERA SENIOR LIVING OF COLUMBUS
Other - Org Type:Doing Business As
Authorized Official - Title/Position:CO-PRESIDENT OF MANAGEMENT COMPANY
Authorized Official - Prefix:
Authorized Official - First Name:GREG
Authorized Official - Middle Name:
Authorized Official - Last Name:ECHOLS
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:815-935-1992
Mailing Address - Street 1:4882 N CONVENT ST
Mailing Address - Street 2:
Mailing Address - City:BOURBONNAIS
Mailing Address - State:IL
Mailing Address - Zip Code:60914-1461
Mailing Address - Country:US
Mailing Address - Phone:815-935-1992
Mailing Address - Fax:815-935-8380
Practice Address - Street 1:1971 STATE ST
Practice Address - Street 2:
Practice Address - City:COLUMBUS
Practice Address - State:IN
Practice Address - Zip Code:47201-6965
Practice Address - Country:US
Practice Address - Phone:812-376-0698
Practice Address - Fax:812-376-0713
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2020-05-22
Last Update Date:2023-10-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes310400000XNursing & Custodial Care FacilitiesAssisted Living Facility