Healthcare Provider Details

I. General information

NPI: 1174300669
Provider Name (Legal Business Name): COMMUNITY OHIO
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 09/11/2023
Last Update Date: 09/11/2023
Certification Date: 09/09/2023
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1313 E BROAD ST
COLUMBUS OH
43205-3500
US

IV. Provider business mailing address

2321 TAYLOR PARK DR # 1036
REYNOLDSBURG OH
43068-8052
US

V. Phone/Fax

Practice location:
  • Phone: 614-500-6159
  • Fax:
Mailing address:
  • Phone: 520-416-6639
  • Fax: 877-540-0067

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code101YM0800X
TaxonomyMental Health Counselor
License Number
License Number State
# 2
Primary TaxonomyN
Taxonomy Code251B00000X
TaxonomyCase Management Agency
License Number
License Number State
# 3
Primary TaxonomyN
Taxonomy Code251S00000X
TaxonomyCommunity/Behavioral Health Agency
License Number
License Number State
# 4
Primary TaxonomyN
Taxonomy Code261QC1500X
TaxonomyCommunity Health Clinic/Center
License Number
License Number State
# 5
Primary TaxonomyY
Taxonomy Code261QM0801X
TaxonomyMental Health Clinic/Center (Including Community Mental Health Center)
License Number
License Number State

VIII. Authorized Official

Name: SHEONKEI GIVNER
Title or Position: CEO
Credential:
Phone: 731-935-9267