Organization
OHIO LIVING COMMUNITIES
Active
Other names
Ohio Living Breckenridge Village
Organization subpart
No
Provider details
NPI number
Authorized official
LAURENCE C GUMINA (CEO)
(614) 888-7800
Entity
Organization
Contact information
Practice address
36855 RIDGE RD, WILLOUGHBY, OH 44094-4128
(440) 942-4342
(440) 942-4150
Mailing address
9200 WORTHINGTON RD STE 300, WESTERVILLE, OH 43082-7240
(614) 888-7800
(614) 888-6864
Taxonomy
Speciality
Code
Description
License number
State
314000000X
Skilled Nursing Facility
Primary
4807
OH
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
000000216305
ANTHEM BC/BS
OH
05
—
0489243
—
OH
Enumeration date
09/25/2005
Last updated
04/15/2024
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