Healthcare Provider Details

I. General information

NPI: 1427436021
Provider Name (Legal Business Name): JEFFREY DEAN FOUNDATION
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 05/14/2015
Last Update Date: 05/14/2015
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2572 CLEVELAND AVE
COLUMBUS OH
43211-1679
US

IV. Provider business mailing address

2572 CLEVELAND AVE
COLUMBUS OH
43211-1679
US

V. Phone/Fax

Practice location:
  • Phone: 614-778-6219
  • Fax:
Mailing address:
  • Phone: 614-778-6219
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code171WH0202X
TaxonomyHome Modifications Contractor
License Number
License Number State

VIII. Authorized Official

Name: MR. RYAN K PEAKS SR.
Title or Position: DIRECTOR
Credential:
Phone: 614-398-1311