Healthcare Provider Details

I. General information

NPI: 1043982531
Provider Name (Legal Business Name): REALCARE COLUMBUS LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 10/02/2021
Last Update Date: 10/02/2021
Certification Date: 10/02/2021
Deactivation Date:
Reactivation Date:

III. Provider practice location address

8137 LINDEN LEAF CIR
COLUMBUS OH
43235-4618
US

IV. Provider business mailing address

8137 LINDEN LEAF CIR
COLUMBUS OH
43235-4618
US

V. Phone/Fax

Practice location:
  • Phone: 614-682-2733
  • Fax:
Mailing address:
  • Phone: 614-682-2733
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code251E00000X
TaxonomyHome Health Agency
License Number
License Number State
# 2
Primary TaxonomyN
Taxonomy Code311Z00000X
TaxonomyCustodial Care Facility
License Number
License Number State
# 3
Primary TaxonomyN
Taxonomy Code311ZA0620X
TaxonomyAdult Care Home Facility
License Number
License Number State
# 4
Primary TaxonomyN
Taxonomy Code347C00000X
TaxonomyPrivate Vehicle
License Number
License Number State
# 5
Primary TaxonomyY
Taxonomy Code253Z00000X
TaxonomyIn Home Supportive Care Agency
License Number
License Number State

VIII. Authorized Official

Name: MR. TRACY LINHART II
Title or Position: DIRECTOR OF STRATEGY AND INNOVATION
Credential:
Phone: 937-545-4159