MEDICARE: NORTHEAST OHIO AGING SERVICES

Medicare Provider Information

Scope of Practice

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

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	314000000X	Skilled Nursing Facility

General Provider Information

NPI Number	:	1346683091
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	NORTHEAST OHIO AGING SERVICES

Provider Business Mailing Address
First Line	:	17 S HIGH ST
Second Line	:	SUITE 1000
City	:	COLUMBUS
State	:	OH
Zip	:	43215-3413
Country	:	US
Telephone Number	:	614-228-9131
Fax Number	:	614-228-7702

Provider Business Practice Location Address
First Line	:	17 S HIGH ST
Second Line	:	SUITE 1000
City	:	COLUMBUS
State	:	OH
Zip	:	43215-3413
Country	:	US
Telephone Number	:	614-228-9131
Fax Number	:	614-228-7702

Authorized Official
Title or Position	:	PRESIDENT
Name	:	LAUREN ROCK
Credential	:
Telephone Number	:	614-228-9131

Provider Enumeration Date	:	04/12/2013
Last Update Date	:	04/12/2013

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