Healthcare Provider Details

I. General information

NPI: 1275349573
Provider Name (Legal Business Name): MIDWESTERN SUPPORTED LIVING INC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 12/10/2024
Last Update Date: 12/10/2024
Certification Date: 12/10/2024
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2765 S HAMILTON RD
COLUMBUS OH
43232-4904
US

IV. Provider business mailing address

2765 S HAMILTON RD
COLUMBUS OH
43232-4904
US

V. Phone/Fax

Practice location:
  • Phone: 614-646-0474
  • Fax:
Mailing address:
  • Phone: 614-646-0474
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code251E00000X
TaxonomyHome Health Agency
License Number
License Number State
# 2
Primary TaxonomyN
Taxonomy Code253Z00000X
TaxonomyIn Home Supportive Care Agency
License Number
License Number State
# 3
Primary TaxonomyN
Taxonomy Code310400000X
TaxonomyAssisted Living Facility
License Number
License Number State

VIII. Authorized Official

Name: PAPE NDIAYE
Title or Position: PRESIDENT
Credential:
Phone: 419-654-0838