Healthcare Provider Details

I. General information

NPI: 1356197867
Provider Name (Legal Business Name): CENTRAL OHIO TRANSITIONAL INITIATIVE / FOUNDATION
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 04/25/2024
Last Update Date: 04/25/2024
Certification Date: 01/16/2024
Deactivation Date:
Reactivation Date:

III. Provider practice location address

5263 KORNWAL DR
COLUMBUS OH
43232-2816
US

IV. Provider business mailing address

PO BOX 13432
COLUMBUS OH
43213-0432
US

V. Phone/Fax

Practice location:
  • Phone: 614-374-3578
  • Fax:
Mailing address:
  • Phone: 614-374-3578
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code101YA0400X
TaxonomyAddiction (Substance Use Disorder) Counselor
License Number
License Number State
# 2
Primary TaxonomyN
Taxonomy Code101YM0800X
TaxonomyMental Health Counselor
License Number
License Number State
# 3
Primary TaxonomyN
Taxonomy Code251S00000X
TaxonomyCommunity/Behavioral Health Agency
License Number
License Number State
# 4
Primary TaxonomyN
Taxonomy Code347C00000X
TaxonomyPrivate Vehicle
License Number
License Number State

VIII. Authorized Official

Name: MR. KENNETH GOLDEN
Title or Position: CHIEF DIRECTOR - FOUNDER
Credential:
Phone: 614-374-3578