MEDICARE: COLUMBUS SENIOR LIVING LLC

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	310400000X	Assisted Living Facility

General Provider Information

NPI Number	:	1003676123
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	COLUMBUS SENIOR LIVING LLC

Provider Business Mailing Address
First Line	:	4300 W GOELLER BLVD
Second Line	:
City	:	COLUMBUS
State	:	IN
Zip	:	47201-8050
Country	:	US
Telephone Number	:	260-452-4896
Fax Number	:

Provider Business Practice Location Address
First Line	:	4300 W GOELLER BLVD
Second Line	:
City	:	COLUMBUS
State	:	IN
Zip	:	47201-8050
Country	:	US
Telephone Number	:	260-452-4896
Fax Number	:

Authorized Official
Title or Position	:	DIRECTOR OF BUSINESS OFFICE AND WAI
Name	:	KRIS PETERS
Credential	:
Telephone Number	:	260-452-4896

Provider Enumeration Date	:	03/19/2024
Last Update Date	:	03/19/2024

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