Healthcare Provider Details

I. General information

NPI: 1336306026
Provider Name (Legal Business Name): CENTRAL OHIO NURSING AGENCY, LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 05/20/2008
Last Update Date: 05/20/2008
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

4770 INDIANOLA AVE SUITE 270
COLUMBUS OH
43214-1862
US

IV. Provider business mailing address

4770 INDIANOLA AVE SUITE 270
COLUMBUS OH
43214-1862
US

V. Phone/Fax

Practice location:
  • Phone: 614-598-6396
  • Fax: 614-781-0208
Mailing address:
  • Phone: 614-598-6396
  • Fax: 614-781-0208

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code251J00000X
TaxonomyNursing Care Agency
License Number251J00000X
License Number StateOH

VIII. Authorized Official

Name: MISS SOPHIA LOREN BERRY STVICTOR
Title or Position: CEO/ PRESIDENT
Credential:
Phone: 614-598-6396