Healthcare Provider Details

I. General information

NPI: 1740274125
Provider Name (Legal Business Name): SANCTUARY AT TUTTLE CROSSING INC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 08/31/2005
Last Update Date: 05/21/2008
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

4880 TUTTLE RD
DUBLIN OH
43017-7530
US

IV. Provider business mailing address

PO BOX 8309 1207 N HIGH ST
COLUMBUS OH
43201-0309
US

V. Phone/Fax

Practice location:
  • Phone: 614-336-4182
  • Fax: 614-336-4187
Mailing address:
  • Phone: 614-299-3100
  • Fax: 614-299-3813

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code314000000X
TaxonomySkilled Nursing Facility
License Number2195
License Number StateOH

VIII. Authorized Official

Name: DR. ROBERT C BANASIK
Title or Position: PRESIDENT
Credential: PHD
Phone: 614-299-3100