Healthcare Provider Details

I. General information

NPI: 1760478952
Provider Name (Legal Business Name): OHIO LIVING COMMUNITIES
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 09/22/2005
Last Update Date: 04/15/2024
Certification Date: 04/15/2024
Deactivation Date:
Reactivation Date:

III. Provider practice location address

3003 CISCO RD
SIDNEY OH
45365-9343
US

IV. Provider business mailing address

9200 WORTHINGTON RD STE 300
WESTERVILLE OH
43082-7240
US

V. Phone/Fax

Practice location:
  • Phone: 937-498-2391
  • Fax: 937-498-7577
Mailing address:
  • Phone: 614-888-7800
  • Fax: 614-888-6864

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code314000000X
TaxonomySkilled Nursing Facility
License Number1592N
License Number StateOH

VIII. Authorized Official

Name: LAURENCE C GUMINA
Title or Position: CEO
Credential:
Phone: 614-888-7800