=====================================================
General NPI Number Information
=====================================================
NPI Number | 1184626285
-----------------------------------------------------
Entity Type | Organization
-----------------------------------------------------
Legal Business Name | GAHANNA HEALTH CARE CENTER, INC.
-----------------------------------------------------
=====================================================
Dates
=====================================================
Enumeration Date | 06/02/2005
-----------------------------------------------------
Last Update Date | 09/11/2025
-----------------------------------------------------
=====================================================
Provider Practice Location Address
=====================================================
Address Line | 121 JAMES RD
-----------------------------------------------------
City | GAHANNA
-----------------------------------------------------
State | OH
-----------------------------------------------------
Zip | 43230-2825
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 614-475-7222
-----------------------------------------------------
Fax | 614-475-2982
-----------------------------------------------------
=====================================================
Provider Business Mailing Address
=====================================================
Address Line | 22021 BROOKPARK RD STE 123
-----------------------------------------------------
City | FAIRVIEW PARK
-----------------------------------------------------
State | OH
-----------------------------------------------------
Zip | 44126-3100
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 440-614-0160
-----------------------------------------------------
Fax | 440-614-0168
-----------------------------------------------------
=====================================================
Authorized Official
=====================================================
Title or Position | PRESIDENT
-----------------------------------------------------
Name | BRIAN COLLERAN
-----------------------------------------------------
Credential |
-----------------------------------------------------
Telephone | 440-614-0160
-----------------------------------------------------
=====================================================
Scope of Practice (Provider's specialty)
=====================================================
Taxonomy #1
-----------------------------------------------------
Taxonomy Code | 314000000X
-----------------------------------------------------
Taxonomy Name | Skilled Nursing Facility
-----------------------------------------------------
License Number | 1730N
-----------------------------------------------------
License Number State | OH
-----------------------------------------------------
Taxonomy #2
-----------------------------------------------------
Taxonomy Code | 332BP3500X
-----------------------------------------------------
Taxonomy Name | Parenteral & Enteral Nutrition Supplies (DME)
-----------------------------------------------------
License Number | 1730
-----------------------------------------------------
License Number State | OH
-----------------------------------------------------