MEDICARE: MIDWESTERN SUPPORTED LIVING INC

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy
1	253Z00000X	In Home Supportive Care Agency
2	310400000X	Assisted Living Facility
3	251E00000X	Home Health Agency

General Provider Information

NPI Number	:	1275349573
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	MIDWESTERN SUPPORTED LIVING INC

Provider Business Mailing Address
First Line	:	2765 S HAMILTON RD
Second Line	:
City	:	COLUMBUS
State	:	OH
Zip	:	43232-4904
Country	:	US
Telephone Number	:	614-646-0474
Fax Number	:

Provider Business Practice Location Address
First Line	:	2765 S HAMILTON RD
Second Line	:
City	:	COLUMBUS
State	:	OH
Zip	:	43232-4904
Country	:	US
Telephone Number	:	614-646-0474
Fax Number	:

Authorized Official
Title or Position	:	PRESIDENT
Name	:	PAPE NDIAYE
Credential	:
Telephone Number	:	419-654-0838

Provider Enumeration Date	:	12/10/2024
Last Update Date	:	12/10/2024

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