Provider Demographics
NPI:1194507491
Name:COMMUNITY HERITAGE EXPERIENCE LLC
Entity type:Organization
Organization Name:COMMUNITY HERITAGE EXPERIENCE LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:CEO
Authorized Official - Prefix:
Authorized Official - First Name:EMMANUEL
Authorized Official - Middle Name:K
Authorized Official - Last Name:CHARLES-MAGAO
Authorized Official - Suffix:
Authorized Official - Credentials:CEO
Authorized Official - Phone:614-603-6872
Mailing Address - Street 1:6777 GAFFORD DR
Mailing Address - Street 2:
Mailing Address - City:COLUMBUS
Mailing Address - State:OH
Mailing Address - Zip Code:43229-1281
Mailing Address - Country:US
Mailing Address - Phone:614-603-6872
Mailing Address - Fax:
Practice Address - Street 1:6777 GAFFORD DR
Practice Address - Street 2:
Practice Address - City:COLUMBUS
Practice Address - State:OH
Practice Address - Zip Code:43229-1281
Practice Address - Country:US
Practice Address - Phone:614-603-6872
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2023-10-20
Last Update Date:2023-10-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes385HR2060XRespite Care FacilityRespite CareRespite Care, Intellectual and/or Developmental Disabilities, Child