Healthcare Provider Details

I. General information

NPI: 1316911407
Provider Name (Legal Business Name): LIVING CARE ALTERNATIVES OF KIRKERSVILLE INC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 02/15/2006
Last Update Date: 02/06/2008
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

205 E MAIN ST
KIRKERSVILLE OH
43033
US

IV. Provider business mailing address

855 S SUNBURY RD
WESTERVILLE OH
43081
US

V. Phone/Fax

Practice location:
  • Phone: 740-927-3209
  • Fax: 740-927-4822
Mailing address:
  • Phone: 614-890-2900
  • Fax: 614-898-1993

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code313M00000X
TaxonomyNursing Facility/Intermediate Care Facility
License Number4176
License Number StateOH

VIII. Authorized Official

Name: MR. THOMAS J ROSSER
Title or Position: PRESIDENT
Credential:
Phone: 614-890-2900