Provider Demographics
NPI:1417775479
Name:BUCKEYE ADULT GROUP CARE LLC
Entity type:Organization
Organization Name:BUCKEYE ADULT GROUP CARE LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER/CEO
Authorized Official - Prefix:
Authorized Official - First Name:NATASHA
Authorized Official - Middle Name:
Authorized Official - Last Name:ELLISON
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:614-364-6943
Mailing Address - Street 1:508 AUTUMN RIDGE CIR
Mailing Address - Street 2:
Mailing Address - City:PICKERINGTON
Mailing Address - State:OH
Mailing Address - Zip Code:43147-7837
Mailing Address - Country:US
Mailing Address - Phone:614-364-6943
Mailing Address - Fax:
Practice Address - Street 1:508 AUTUMN RIDGE CIR
Practice Address - Street 2:
Practice Address - City:PICKERINGTON
Practice Address - State:OH
Practice Address - Zip Code:43147-7837
Practice Address - Country:US
Practice Address - Phone:614-364-6943
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2024-09-30
Last Update Date:2024-09-30
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes251E00000XAgenciesHome Health