Healthcare Provider Details

I. General information

NPI: 1154169845
Provider Name (Legal Business Name): HERITAGE SENIOR LIVING OF PLAIN CITY LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 07/17/2024
Last Update Date: 07/17/2024
Certification Date: 07/17/2024
Deactivation Date:
Reactivation Date:

III. Provider practice location address

11351 LAFAYETTE PLAIN CITY RD
PLAIN CITY OH
43064-8519
US

IV. Provider business mailing address

11351 LAFAYETTE PLAIN CITY RD
PLAIN CITY OH
43064-8519
US

V. Phone/Fax

Practice location:
  • Phone: 614-873-9700
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code310400000X
TaxonomyAssisted Living Facility
License Number
License Number State

VII. Legacy identifiers

For crosswalk purposes, the following legacy (non-NPI) identifiers are available for this provider:

VIII. Authorized Official

Name: NICK PATEL
Title or Position: CFO
Credential:
Phone: 631-885-5218