MEDICARE: COLUMBUS WEST PARK HOME HEALTH & ADULT DAY SERVICES 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	251E00000X	Home Health Agency	1505377	OH

General Provider Information

NPI Number	:	1689083214
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	COLUMBUS WEST PARK HOME HEALTH & ADULT DAY SERVICES LLC

Provider Business Mailing Address
First Line	:	2731 CLIME RD
Second Line	:
City	:	COLUMBUS
State	:	OH
Zip	:	43223-3625
Country	:	US
Telephone Number	:
Fax Number	:

Provider Business Practice Location Address
First Line	:	2731 CLIME RD
Second Line	:
City	:	COLUMBUS
State	:	OH
Zip	:	43223-3625
Country	:	US
Telephone Number	:	614-274-4005
Fax Number	:

Authorized Official
Title or Position	:	ADMINISTRATOR
Name	:	BRYANT MOHLER
Credential	:
Telephone Number	:	614-274-4005

Provider Enumeration Date	:	08/07/2014
Last Update Date	:	08/07/2014

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