Healthcare Provider Details

I. General information

NPI: 1790600377
Provider Name (Legal Business Name): FRIENDSHIP SUPPORTED LIVING INC.
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 08/12/2026
Last Update Date: 08/12/2026
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1251 GREENLEAF RD.
COLUMBUS OH
43223-3824
US

IV. Provider business mailing address

1251 GREENLEAF RD.
COLUMBUS OH
43223-3824
US

V. Phone/Fax

Practice location:
  • Phone: 614-207-8732
  • Fax: 614-276-8777
Mailing address:
  • Phone: 614-207-8732
  • Fax: 614-276-8777

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code103TM1800X
TaxonomyIntellectual & Developmental Disabilities Psychologist
License Number
License Number State
# 2
Primary TaxonomyN
Taxonomy Code253Z00000X
TaxonomyIn Home Supportive Care Agency
License Number
License Number State

VIII. Authorized Official

Name: MISS FLORENCE CARLISA HEIN
Title or Position: PRES-OWNER
Credential:
Phone: 614-207-8732