Provider Demographics
NPI:1053987685
Name:SCIOTO ASSISTED LIVING
Entity type:Organization
Organization Name:SCIOTO ASSISTED LIVING
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESDIENT
Authorized Official - Prefix:
Authorized Official - First Name:KENNETH
Authorized Official - Middle Name:J
Authorized Official - Last Name:BERNSEN
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:937-277-0505
Mailing Address - Street 1:6479 REFLECTIONS DR
Mailing Address - Street 2:
Mailing Address - City:DUBLIN
Mailing Address - State:OH
Mailing Address - Zip Code:43017-2374
Mailing Address - Country:US
Mailing Address - Phone:614-659-0961
Mailing Address - Fax:
Practice Address - Street 1:433 OBETZ RD
Practice Address - Street 2:
Practice Address - City:COLUMBUS
Practice Address - State:OH
Practice Address - Zip Code:43207-4098
Practice Address - Country:US
Practice Address - Phone:614-491-2000
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:Yes
Parent Organization LBN:CHS OF SCIOTO OPERATING COMPANY INC
Parent Organization TIN:<UNAVAIL>
Enumeration Date:2021-06-03
Last Update Date:2021-06-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes310400000XNursing & Custodial Care FacilitiesAssisted Living Facility