Healthcare Provider Details

I. General information

NPI: 1205595022
Provider Name (Legal Business Name): SO CREATIVE LIVING PLANS, LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 12/08/2021
Last Update Date: 12/09/2021
Certification Date: 12/09/2021
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1761 PARSONS AVE
COLUMBUS OH
43207-2291
US

IV. Provider business mailing address

1761 PARSONS AVE
COLUMBUS OH
43207-2291
US

V. Phone/Fax

Practice location:
  • Phone: 614-783-0428
  • Fax:
Mailing address:
  • Phone: 614-783-0428
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code251E00000X
TaxonomyHome Health Agency
License Number
License Number StateNULL
# 2
Primary TaxonomyN
Taxonomy Code177F00000X
TaxonomyLodging Provider
License Number
License Number StateNULL
# 3
Primary TaxonomyY
Taxonomy Code253Z00000X
TaxonomyIn Home Supportive Care Agency
License Number
License Number StateNULL
# 4
Primary TaxonomyN
Taxonomy Code174200000X
TaxonomyMeals Provider
License Number
License Number StateNULL

VIII. Authorized Official

Name: RAS JAHLANI BEN-LEVI
Title or Position: OWNER
Credential:
Phone: 614-783-0428