Provider Demographics
NPI:1194722744
Name:WORTHINGTON CHRISTIAN VILLAGE, INC.
Entity type:Organization
Organization Name:WORTHINGTON CHRISTIAN VILLAGE, INC.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:EXECUTIVE DIRECTOR
Authorized Official - Prefix:MR
Authorized Official - First Name:RANDY
Authorized Official - Middle Name:
Authorized Official - Last Name:RICHARDSON
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:614-846-6076
Mailing Address - Street 1:165 HIGHBLUFFS BLVD
Mailing Address - Street 2:
Mailing Address - City:COLUMBUS
Mailing Address - State:OH
Mailing Address - Zip Code:43235-1484
Mailing Address - Country:US
Mailing Address - Phone:614-846-6076
Mailing Address - Fax:614-842-9541
Practice Address - Street 1:165 HIGHBLUFFS BLVD
Practice Address - Street 2:
Practice Address - City:COLUMBUS
Practice Address - State:OH
Practice Address - Zip Code:43235-1484
Practice Address - Country:US
Practice Address - Phone:614-846-6076
Practice Address - Fax:614-842-9541
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2005-06-28
Last Update Date:2020-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OH1838R310400000X
OH1838313M00000X, 314000000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Not Answered310400000XNursing & Custodial Care FacilitiesAssisted Living Facility
Not Answered313M00000XNursing & Custodial Care FacilitiesNursing Facility/Intermediate Care Facility
Not Answered314000000XNursing & Custodial Care FacilitiesSkilled Nursing Facility
Provider Identifiers
StateIdentifier IDID TypeIssuer
OH0619352Medicaid
OH365671Medicare ID - Type UnspecifiedMEDICARE #