MEDICARE: DISABILITY SUPPORT SYSTEMS OF OHIO,LLC

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	251C00000X	Developmentally Disabled Services Day Training Agency
2	253Z00000X	In Home Supportive Care Agency

General Provider Information

NPI Number	:	1366793382
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	DISABILITY SUPPORT SYSTEMS OF OHIO,LLC

Provider Business Mailing Address
First Line	:	1915 GREENWAY AVE N
Second Line	:
City	:	COLUMBUS
State	:	OH
Zip	:	43219-2915
Country	:	US
Telephone Number	:	614-440-6782
Fax Number	:

Provider Business Practice Location Address
First Line	:	1915 GREENWAY AVE N
Second Line	:
City	:	COLUMBUS
State	:	OH
Zip	:	43219-2915
Country	:	US
Telephone Number	:	614-440-6782
Fax Number	:

Authorized Official
Title or Position	:	OWNER
Name	:	MS. DANIELLE K KIBBY
Credential	:
Telephone Number	:	614-440-6782

Provider Enumeration Date	:	10/01/2012
Last Update Date	:	10/01/2012

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