Provider Demographics
NPI:1730247024
Name:FRIENDSHIP VILLAGE OF COLUMBUS OHIO INC
Entity type:Organization
Organization Name:FRIENDSHIP VILLAGE OF COLUMBUS OHIO INC
Other - Org Name:<UNAVAIL>
Other - Org Type:
Authorized Official - Title/Position:DIRECTOR OF ACCOUNTING
Authorized Official - Prefix:
Authorized Official - First Name:LAURA
Authorized Official - Middle Name:
Authorized Official - Last Name:CHANAK
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:614-890-8282
Mailing Address - Street 1:5800 FOREST HILLS BLVD
Mailing Address - Street 2:
Mailing Address - City:COLUMBUS
Mailing Address - State:OH
Mailing Address - Zip Code:43231-6916
Mailing Address - Country:US
Mailing Address - Phone:614-890-8282
Mailing Address - Fax:614-890-2661
Practice Address - Street 1:5757 PONDEROSA DR
Practice Address - Street 2:
Practice Address - City:COLUMBUS
Practice Address - State:OH
Practice Address - Zip Code:43231-3102
Practice Address - Country:US
Practice Address - Phone:614-890-8287
Practice Address - Fax:614-891-6662
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-12-05
Last Update Date:2024-12-31
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OH2835314000000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes314000000XNursing & Custodial Care FacilitiesSkilled Nursing Facility
Provider Identifiers
StateIdentifier IDID TypeIssuer
OH365399OtherPTAN
OH0383428Medicaid
OH0383428Medicaid