Healthcare Provider Details

I. General information

NPI: 1891778536
Provider Name (Legal Business Name): FRIENDSHIP VILLAGE OF DUBLIN OHIO, INC.
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 11/28/2005
Last Update Date: 08/28/2019
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

6000 RIVERSIDE DR
DUBLIN OH
43017
US

IV. Provider business mailing address

6000 RIVERSIDE DR
DUBLIN OH
43017-1492
US

V. Phone/Fax

Practice location:
  • Phone: 614-764-1600
  • Fax: 614-746-7466
Mailing address:
  • Phone: 614-764-1600
  • Fax: 614-746-7466

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code314000000X
TaxonomySkilled Nursing Facility
License Number1746N
License Number StateOH

VIII. Authorized Official

Name: JESSICA ASHLEY RIEKER
Title or Position: ADMINISTRATOR
Credential: NHA
Phone: 614-717-1600