Healthcare Provider Details

I. General information

NPI: 1174159347
Provider Name (Legal Business Name): TAWAIN GORDON
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 03/19/2020
Last Update Date: 09/24/2025
Certification Date: 09/24/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

5875 CHANTRY DR STE A
COLUMBUS OH
43232-4764
US

IV. Provider business mailing address

3192 CHELFORD DR
COLUMBUS OH
43219-3263
US

V. Phone/Fax

Practice location:
  • Phone: 614-419-9493
  • Fax:
Mailing address:
  • Phone: 614-419-9493
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code251E00000X
TaxonomyHome Health Agency
License Number
License Number State
# 2
Primary TaxonomyY
Taxonomy Code171M00000X
TaxonomyCase Manager/Care Coordinator
License Number
License Number State

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: