Healthcare Provider Details

I. General information

NPI: 1932810447
Provider Name (Legal Business Name): HSD SUPPORTIVE LIVING LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 12/06/2022
Last Update Date: 12/06/2022
Certification Date: 12/06/2022
Deactivation Date:
Reactivation Date:

III. Provider practice location address

249 BEECHNUT ST
PICKERINGTON OH
43147-7977
US

IV. Provider business mailing address

249 BEECHNUT ST
PICKERINGTON OH
43147-7977
US

V. Phone/Fax

Practice location:
  • Phone: 614-632-2545
  • Fax:
Mailing address:
  • Phone: 614-632-2545
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code251E00000X
TaxonomyHome Health Agency
License Number
License Number State

VIII. Authorized Official

Name: MRS. ANDREA HAIRSTON
Title or Position: OWNER/DOO
Credential:
Phone: 614-632-2545