MEDICARE: SENIOR HOME CARE OF CENTRAL 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	253Z00000X	In Home Supportive Care Agency		OH

General Provider Information

NPI Number	:	1497142707
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	SENIOR HOME CARE OF CENTRAL OHIO, LLC

Provider Business Mailing Address
First Line	:	5105 SAINT ANDREWS DR
Second Line	:
City	:	WESTERVILLE
State	:	OH
Zip	:	43082-8718
Country	:	US
Telephone Number	:	614-701-0196
Fax Number	:

Provider Business Practice Location Address
First Line	:	5105 SAINT ANDREWS DR
Second Line	:
City	:	WESTERVILLE
State	:	OH
Zip	:	43082-8718
Country	:	US
Telephone Number	:	614-701-0196
Fax Number	:

Authorized Official
Title or Position	:	MANAGING DIRECTOR
Name	:	JEFF BERNARD CULLEN
Credential	:
Telephone Number	:	614-701-0196

Provider Enumeration Date	:	04/24/2015
Last Update Date	:	01/27/2016

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