Club for the Ages LLC

Primary specialty

Non-emergency Medical Transport (VAN)Taxonomy code 343900000X

Legal business name

CLUB FOR THE AGES LLC

Practice address

1196 W Broad St
Columbus, OH 43222-1319

Phone

(614) 276-0408

Fax

(614) 276-0644

NPI assigned

Feb 11, 2007

Organization subpart

No

Registry information is reported by the provider to CMS and is not verified. About this source

Authorized official

Name

Mr. Edward C Mulligan

Title

Vice President

Phone

(614) 570-9795

Specialties & licenses 2

Addresses

Medicare fee-for-service enrollment

Not listed in the public Medicare enrollment file

Locations

The complete NPPES record for this NPI in the NPI Registry API format.

{
    "created_epoch": "1171152000000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1215475200000",
    "number": "1679614671",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "1196 W BROAD ST",
            "city": "COLUMBUS",
            "state": "OH",
            "postal_code": "432221319",
            "telephone_number": "614-276-0408",
            "fax_number": "614-276-0644"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "1196 W BROAD ST",
            "city": "COLUMBUS",
            "state": "OH",
            "postal_code": "432221319",
            "telephone_number": "614-276-0408",
            "fax_number": "614-276-0644"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "CLUB FOR THE AGES LLC",
        "organizational_subpart": "NO",
        "enumeration_date": "2007-02-11",
        "last_updated": "2008-07-08",
        "status": "A",
        "authorized_official_last_name": "MULLIGAN",
        "authorized_official_first_name": "EDWARD",
        "authorized_official_middle_name": "C",
        "authorized_official_title_or_position": "VICE PRESIDENT",
        "authorized_official_telephone_number": "614-570-9795",
        "authorized_official_name_prefix": "Mr."
    },
    "taxonomies": [
        {
            "code": "343900000X",
            "taxonomy_group": "",
            "desc": "Non-emergency Medical Transport (VAN)",
            "state": "OH",
            "license": null,
            "primary": true
        },
        {
            "code": "374U00000X",
            "taxonomy_group": "193400000X SINGLE SPECIALTY  GROUP",
            "desc": "Home Health Aide",
            "state": null,
            "license": null,
            "primary": false
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

• Zack Clouse, PA-C
• Sarah M Clow, LISW
• Colleen Patricia Cloyd, PHARMD, BCPPS
• Jordan M Cloyd, MD
• Rebecca R. Cloyes, APRN-CNP
• Kevin L Cluts, LISW-S
• Carmen Marie Clutter, MS, RDN, LD
• Mason Clutter, OD, MS
• Leisa Clymer, PH.D.
• Rebecca Cmar, DPT

• Non-emergency Medical Transport (VAN) in Columbus, OH
• Providers in Columbus, OH by specialty
• Non-emergency Medical Transport (VAN) in Ohio

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Jul 8, 2008; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
• Medicare enrollment (CMS PECOS): enrollments, PAC IDs and benefit reassignments; OIG LEIE.
• National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.