Organization
CLUB FOR THE AGES LLC
Active
Organization subpart
No
Provider details
NPI number
Authorized official
MR. EDWARD C MULLIGAN (VICE PRESIDENT)
(614) 570-9795
Entity
Organization
Contact information
Practice address
1196 W BROAD ST, COLUMBUS, OH 43222-1319
(614) 276-0408
(614) 276-0644
Mailing address
1196 W BROAD ST, COLUMBUS, OH 43222-1319
(614) 276-0408
(614) 276-0644
Taxonomy
Speciality
Code
Description
License number
State
343900000X
Non-emergency Medical Transport (VAN)
Primary
—
OH
374U00000X
Home Health Aide
—
—
Other
Enumeration date
02/11/2007
Last updated
07/08/2008
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