Provider Demographics
NPI:1316657240
Name:LIVING LIFE HOMECARE II LLC
Entity type:Organization
Organization Name:LIVING LIFE HOMECARE II LLC
Other - Org Name:<UNAVAIL>
Other - Org Type:
Authorized Official - Title/Position:CEO
Authorized Official - Prefix:
Authorized Official - First Name:EBENEZER
Authorized Official - Middle Name:A
Authorized Official - Last Name:MENSAHADDISON
Authorized Official - Suffix:
Authorized Official - Credentials:RN
Authorized Official - Phone:614-322-3210
Mailing Address - Street 1:2323 LAKE CLUB DR STE 102
Mailing Address - Street 2:
Mailing Address - City:COLUMBUS
Mailing Address - State:OH
Mailing Address - Zip Code:43232-3198
Mailing Address - Country:US
Mailing Address - Phone:614-322-9210
Mailing Address - Fax:614-322-9214
Practice Address - Street 1:2323 LAKE CLUB DR STE 102
Practice Address - Street 2:
Practice Address - City:COLUMBUS
Practice Address - State:OH
Practice Address - Zip Code:43232-3198
Practice Address - Country:US
Practice Address - Phone:614-322-9210
Practice Address - Fax:614-322-9214
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2022-12-01
Last Update Date:2023-08-31
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes251E00000XAgenciesHome Health
Provider Identifiers
StateIdentifier IDID TypeIssuer
OH1194066795Medicaid