Healthcare Provider Details

I. General information

NPI: 1477476711
Provider Name (Legal Business Name): SULLIVANT AVENUE COMMUNITY SCHOOL
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 08/03/2026
Last Update Date: 08/03/2026
Certification Date: 08/03/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

3435 SULLIVANT AVE
COLUMBUS OH
43204-1103
US

IV. Provider business mailing address

3435 SULLIVANT AVE
COLUMBUS OH
43204-1103
US

V. Phone/Fax

Practice location:
  • Phone: 614-308-5991
  • Fax:
Mailing address:
  • Phone: 614-308-5991
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code251300000X
TaxonomyLocal Education Agency (LEA)
License Number
License Number State

VIII. Authorized Official

Name: SUSAN BOLLIN
Title or Position: MSP CONSULTANT
Credential:
Phone: 419-346-9651