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NPI Code Detail

MEDICARE: POMEGRANATE HEALTH SYSTEMS OF CENTRAL OHIO, INC.

MEDICARE: POMEGRANATE HEALTH SYSTEMS OF CENTRAL OHIO, INC.
Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

# Taxonomy Code Taxonomy License Number License Number State
1283Q00000XPsychiatric Hospital07-5476OH

General Provider Information

NPI Number : 1730513391
Entity Type Code : Organization
Provider Name (Legal Business Name) : POMEGRANATE HEALTH SYSTEMS OF CENTRAL OHIO, INC.
Provider Business Mailing Address
First Line : 765 PIERCE DR
Second Line :
City : COLUMBUS
State : OH
Zip : 43223-2425
Country : US
Telephone Number : 614-223-1650
Fax Number : 888-727-7834
Provider Business Practice Location Address
First Line : 765 PIERCE DR
Second Line :
City : COLUMBUS
State : OH
Zip : 43223-2425
Country : US
Telephone Number : 614-223-1650
Fax Number : 888-727-7834
Authorized Official
Title or Position : CEO
Name : MRS. ANGELA NICKELL
Credential : MS
Telephone Number : 614-223-1650
Provider Enumeration Date : 08/30/2013
Last Update Date : 08/30/2013

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