MEDICARE: CITY MEDICAL NURSING CENTER 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	251E00000X	Home Health Agency	368065	OH

General Provider Information

NPI Number	:	1902995699
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	CITY MEDICAL NURSING CENTER LLC

Provider Business Mailing Address
First Line	:	5340 E MAIN ST
Second Line	:	SUITE # 212
City	:	COLUMBUS
State	:	OH
Zip	:	43213-2574
Country	:	US
Telephone Number	:	614-759-1191
Fax Number	:	614-759-1391

Provider Business Practice Location Address
First Line	:	5340 E MAIN ST
Second Line	:	SUITE # 212
City	:	COLUMBUS
State	:	OH
Zip	:	43213-2574
Country	:	US
Telephone Number	:	614-759-1191
Fax Number	:	614-759-1391

Authorized Official
Title or Position	:	OWNER
Name	:	MRS. DOROTHY FELIX
Credential	:
Telephone Number	:	614-759-1191

Provider Enumeration Date	:	10/12/2006
Last Update Date	:	03/26/2012

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