Provider Demographics
NPI:1154692838
Name:NATIONAL CHURCH RESIDENCES MEDICAL HOME
Entity type:Organization
Organization Name:NATIONAL CHURCH RESIDENCES MEDICAL HOME
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:
Authorized Official - First Name:BRIANNA
Authorized Official - Middle Name:
Authorized Official - Last Name:METTLER
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:614-451-2151
Mailing Address - Street 1:5475 RINGS RD STE 300
Mailing Address - Street 2:
Mailing Address - City:DUBLIN
Mailing Address - State:OH
Mailing Address - Zip Code:43017-7537
Mailing Address - Country:US
Mailing Address - Phone:614-451-2151
Mailing Address - Fax:614-451-0351
Practice Address - Street 1:398 S GRANT AVE
Practice Address - Street 2:
Practice Address - City:COLUMBUS
Practice Address - State:OH
Practice Address - Zip Code:43215-5549
Practice Address - Country:US
Practice Address - Phone:614-224-2988
Practice Address - Fax:614-716-0902
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2012-01-26
Last Update Date:2025-11-04
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OHNP07477207QA0505X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207QA0505XAllopathic & Osteopathic PhysiciansFamily MedicineAdult MedicineGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
OH0062203Medicaid
OH0062203Medicaid