Healthcare Provider Details

I. General information

NPI: 1154116168
Provider Name (Legal Business Name): CITIZEN HEALTH PA
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 04/10/2025
Last Update Date: 04/10/2025
Certification Date: 04/03/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

175 S 3RD ST STE 200
COLUMBUS OH
43215-5194
US

IV. Provider business mailing address

175 S 3RD ST STE 200
COLUMBUS OH
43215-5194
US

V. Phone/Fax

Practice location:
  • Phone: 844-451-0472
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code2084A0401X
TaxonomyAddiction Medicine (Psychiatry & Neurology) Physician
License Number
License Number State

VIII. Authorized Official

Name: KAMARR BROWN
Title or Position: AUTHORIZED PERSON
Credential:
Phone: 215-709-5670