Provider Demographics
NPI:1275349573
Name:MIDWESTERN SUPPORTED LIVING INC
Entity type:Organization
Organization Name:MIDWESTERN SUPPORTED LIVING INC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:
Authorized Official - First Name:PAPE
Authorized Official - Middle Name:
Authorized Official - Last Name:NDIAYE
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:419-654-0838
Mailing Address - Street 1:2765 S HAMILTON RD
Mailing Address - Street 2:
Mailing Address - City:COLUMBUS
Mailing Address - State:OH
Mailing Address - Zip Code:43232-4904
Mailing Address - Country:US
Mailing Address - Phone:614-646-0474
Mailing Address - Fax:
Practice Address - Street 1:2765 S HAMILTON RD
Practice Address - Street 2:
Practice Address - City:COLUMBUS
Practice Address - State:OH
Practice Address - Zip Code:43232-4904
Practice Address - Country:US
Practice Address - Phone:614-646-0474
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2024-12-10
Last Update Date:2024-12-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes251E00000XAgenciesHome Health
No253Z00000XAgenciesIn Home Supportive Care
No310400000XNursing & Custodial Care FacilitiesAssisted Living Facility