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Organization
MINE LIVING LLC
Active
Organization
MINE LIVING LLC
Active
Organization subpart
No
Provider details
NPI number
Authorized official
ANTHONY QUALLS (OWNER)
(614) 456-9952
Entity
Organization
Contact information
Practice address
6100 CHANNINGWAY BLVD STE 406, COLUMBUS, OH 43232-2910
(614) 456-9952
Mailing address
869 E 13TH AVE, COLUMBUS, OH 43211-2727
(614) 456-9952
Taxonomy
Speciality
Code
Description
License number
State
252Y00000X
Early Intervention Provider Agency
Primary
—
NULL
Other
Enumeration date
04/19/2024
Last updated
04/19/2024
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