Healthcare Provider Details

I. General information

NPI: 1154692838
Provider Name (Legal Business Name): NATIONAL CHURCH RESIDENCES MEDICAL HOME
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 01/26/2012
Last Update Date: 11/04/2025
Certification Date: 11/04/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

398 S GRANT AVE
COLUMBUS OH
43215-5549
US

IV. Provider business mailing address

5475 RINGS RD STE 300
DUBLIN OH
43017-7537
US

V. Phone/Fax

Practice location:
  • Phone: 614-224-2988
  • Fax: 614-716-0902
Mailing address:
  • Phone: 614-451-2151
  • Fax: 614-451-0351

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207QA0505X
TaxonomyAdult Medicine Physician
License NumberNP07477
License Number StateOH

VIII. Authorized Official

Name: BRIANNA METTLER
Title or Position: PRESIDENT
Credential:
Phone: 614-451-2151