Healthcare Provider Details

I. General information

NPI: 1598050734
Provider Name (Legal Business Name): CENTRAL OHIO AREA AGENCY ON AGING
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 06/16/2011
Last Update Date: 06/16/2011
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

174 E LONG ST
COLUMBUS OH
43215-1809
US

IV. Provider business mailing address

174 E LONG ST
COLUMBUS OH
43215-1809
US

V. Phone/Fax

Practice location:
  • Phone: 614-645-7250
  • Fax: 614-645-3884
Mailing address:
  • Phone: 614-645-7250
  • Fax: 614-645-3884

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code104100000X
TaxonomySocial Worker
License Number
License Number State
# 2
Primary TaxonomyN
Taxonomy Code1041C0700X
TaxonomyClinical Social Worker
License Number
License Number State
# 3
Primary TaxonomyN
Taxonomy Code163W00000X
TaxonomyRegistered Nurse
License Number
License Number State
# 4
Primary TaxonomyY
Taxonomy Code163WC0400X
TaxonomyCase Management Registered Nurse
License Number
License Number State

VIII. Authorized Official

Name: MR. PHIL ROLLINS
Title or Position: FISCAL DIRECTOR
Credential:
Phone: 614-645-3877