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General NPI Number Information
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NPI Number | 1770479909
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Entity Type | Organization
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Legal Business Name | H42M SUPPORTED LIVING SERVICES
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Dates
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Enumeration Date | 06/16/2025
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Last Update Date | 06/16/2025
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Provider Practice Location Address
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Address Line | 2323 LAKE CLUB DR
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City | COLUMBUS
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State | OH
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Zip | 43232-3101
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Country | US
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Telephone | 614-266-1079
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Fax |
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Provider Business Mailing Address
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Address Line | 6515 ENCHANTING LN
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City | CANAL WINCHESTER
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State | OH
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Zip | 43110-3610
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Country | US
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Telephone | 614-266-1079
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Fax |
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Authorized Official
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Title or Position | MANAGING MEMBER
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Name | CHARLCIA AGEE
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Credential |
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Telephone | 614-266-1079
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 251E00000X
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Taxonomy Name | Home Health Agency
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License Number |
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License Number State |
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