MEDICARE: EMBASSY FOREST HILLS

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	261QA0600X	Adult Day Care Clinic/Center

General Provider Information

NPI Number	:	1801570221
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	EMBASSY FOREST HILLS

Provider Business Mailing Address
First Line	:	2841 E DUBLIN GRANVILLE RD
Second Line	:
City	:	COLUMBUS
State	:	OH
Zip	:	43231-4037
Country	:	US
Telephone Number	:	614-891-1111
Fax Number	:	614-794-6281

Provider Business Practice Location Address
First Line	:	2841 E DUBLIN GRANVILLE RD
Second Line	:
City	:	COLUMBUS
State	:	OH
Zip	:	43231-4037
Country	:	US
Telephone Number	:	614-891-1111
Fax Number	:	614-794-6281

Authorized Official
Title or Position	:	CHIEF COMPLIANCE OFFICER
Name	:	NICHOLAS CICCONE
Credential	:
Telephone Number	:	216-468-6322

Provider Enumeration Date	:	06/14/2023
Last Update Date	:	06/14/2023

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Directions to “EMBASSY FOREST HILLS ” Practice Location

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