MEDICARE: OHIO LIVING HOLDINGS

Medicare Provider Information

Scope of Practice

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

#	Taxonomy Code	Taxonomy
1	1041C0700X	Clinical Social Worker
2	207QH0002X	Hospice and Palliative Medicine (Family Medicine) Physician
3	363LG0600X	Gerontology Nurse Practitioner
4	364SG0600X	Gerontology Clinical Nurse Specialist
5	207QA0505X	Adult Medicine Physician

General Provider Information

NPI Number	:	1760756910
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	OHIO LIVING HOLDINGS

Provider Business Mailing Address
First Line	:	2740 AIRPORT DR STE 140
Second Line	:
City	:	COLUMBUS
State	:	OH
Zip	:	43219-2296
Country	:	US
Telephone Number	:	614-433-0031
Fax Number	:	614-433-0550

Provider Business Practice Location Address
First Line	:	2740 AIRPORT DR STE 140
Second Line	:
City	:	COLUMBUS
State	:	OH
Zip	:	43219-2296
Country	:	US
Telephone Number	:	614-433-0031
Fax Number	:	614-433-0550

Authorized Official
Title or Position	:	CEO
Name	:	LAURENCE C GUMINA
Credential	:
Telephone Number	:	614-888-7800

Provider Enumeration Date	:	03/06/2012
Last Update Date	:	01/27/2019

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Directions to “OHIO LIVING HOLDINGS ” Practice Location

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