Healthcare Provider Details

I. General information

NPI: 1760756910
Provider Name (Legal Business Name): OHIO LIVING HOLDINGS
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 03/06/2012
Last Update Date: 01/27/2019
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2740 AIRPORT DR STE 140
COLUMBUS OH
43219-2296
US

IV. Provider business mailing address

2740 AIRPORT DR STE 140
COLUMBUS OH
43219-2296
US

V. Phone/Fax

Practice location:
  • Phone: 614-433-0031
  • Fax: 614-433-0550
Mailing address:
  • Phone: 614-433-0031
  • Fax: 614-433-0550

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code1041C0700X
TaxonomyClinical Social Worker
License Number
License Number State
# 2
Primary TaxonomyN
Taxonomy Code207QH0002X
TaxonomyHospice and Palliative Medicine (Family Medicine) Physician
License Number
License Number State
# 3
Primary TaxonomyN
Taxonomy Code363LG0600X
TaxonomyGerontology Nurse Practitioner
License Number
License Number State
# 4
Primary TaxonomyN
Taxonomy Code364SG0600X
TaxonomyGerontology Clinical Nurse Specialist
License Number
License Number State
# 5
Primary TaxonomyY
Taxonomy Code207QA0505X
TaxonomyAdult Medicine Physician
License Number
License Number State

VIII. Authorized Official

Name: LAURENCE C GUMINA
Title or Position: CEO
Credential:
Phone: 614-888-7800