Healthcare Provider Details

I. General information

NPI: 1134726573
Provider Name (Legal Business Name): COMMUNITY LIVING EXPERIENCES, INC.
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 10/08/2020
Last Update Date: 10/08/2020
Certification Date: 10/08/2020
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2939 DONNYLANE BLVD
COLUMBUS OH
43235-3228
US

IV. Provider business mailing address

2939 DONNYLANE BLVD
COLUMBUS OH
43235-3228
US

V. Phone/Fax

Practice location:
  • Phone: 614-588-0320
  • Fax:
Mailing address:
  • Phone: 614-588-0320
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code251X00000X
TaxonomySupports Brokerage 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 Code347C00000X
TaxonomyPrivate Vehicle
License Number
License Number State
# 4
Primary TaxonomyY
Taxonomy Code3747P1801X
TaxonomyPersonal Care Attendant
License Number
License Number State
# 5
Primary TaxonomyN
Taxonomy Code376J00000X
TaxonomyHomemaker
License Number
License Number State

VIII. Authorized Official

Name: NICHOLAS VIARS
Title or Position: BILLING SPECIALIST
Credential:
Phone: 614-588-0320