Organization
H42M SUPPORTED LIVING SERVICES
Active
Organization subpart
No
Provider details
NPI number
Authorized official
CHARLCIA AGEE (MANAGING MEMBER)
(614) 266-1079
Entity
Organization
Contact information
Practice address
2323 LAKE CLUB DR, COLUMBUS, OH 43232-3101
(614) 266-1079
Mailing address
6515 ENCHANTING LN, CANAL WINCHESTER, OH 43110-3610
(614) 266-1079
Taxonomy
Speciality
Code
Description
License number
State
251E00000X
Home Health Agency
Primary
—
—
Other
Enumeration date
06/16/2025
Last updated
06/16/2025
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