Healthcare Provider Details

I. General information

NPI: 1992321392
Provider Name (Legal Business Name): DUBLIN CONVALARIUM OPERATING COMPANY, LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 06/22/2020
Last Update Date: 12/17/2024
Certification Date: 12/17/2024
Deactivation Date:
Reactivation Date:

III. Provider practice location address

6430 POST RD
DUBLIN OH
43016-1226
US

IV. Provider business mailing address

1661 OLD HENDERSON RD
COLUMBUS OH
43220-3644
US

V. Phone/Fax

Practice location:
  • Phone: 614-761-1188
  • Fax:
Mailing address:
  • Phone: 614-459-0445
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code314000000X
TaxonomySkilled Nursing Facility
License Number
License Number State

VIII. Authorized Official

Name: MR. JEFFREY DEGYANSKY
Title or Position: VICE PRESIDENT OF OPERATIONS
Credential: LNHA
Phone: 330-620-7828