Organization
LARK RESIDENTIAL SUPPORT, INC.
Active
Organization subpart
No
Provider details
NPI number
Authorized official
MRS. JOVITA S LARK (RESIDENTIAL DIRECTOR/OWNER OPERATOR)
(614) 785-9941
Entity
Organization
Contact information
Practice address
6161 BUSCH BLVD STE 66, COLUMBUS, OH 43229-2548
(614) 785-9941
(614) 785-9947
Mailing address
5026 SINCLAIR RD, COLUMBUS, OH 43229-5431
(614) 785-9941
(614) 785-9947
Taxonomy
Speciality
Code
Description
License number
State
253Z00000X
In Home Supportive Care Agency
Primary
2550136
OH
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
2957466
—
OH
Enumeration date
05/19/2010
Last updated
12/15/2020
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