Healthcare Provider Details

I. General information

NPI: 1922790914
Provider Name (Legal Business Name): G&D RESOURCE HUB LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 05/25/2023
Last Update Date: 05/25/2023
Certification Date: 05/25/2023
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1234 S CHAMPION AVE
COLUMBUS OH
43206-3028
US

IV. Provider business mailing address

1234 S CHAMPION AVE
COLUMBUS OH
43206-3028
US

V. Phone/Fax

Practice location:
  • Phone: 614-622-5155
  • Fax:
Mailing address:
  • Phone: 614-622-5155
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code251B00000X
TaxonomyCase Management Agency
License Number
License Number State
# 2
Primary TaxonomyN
Taxonomy Code251S00000X
TaxonomyCommunity/Behavioral Health Agency
License Number
License Number State
# 3
Primary TaxonomyN
Taxonomy Code251V00000X
TaxonomyVoluntary or Charitable Agency
License Number
License Number State
# 4
Primary TaxonomyN
Taxonomy Code261QR0800X
TaxonomyRecovery Care Clinic/Center
License Number
License Number State
# 5
Primary TaxonomyN
Taxonomy Code347C00000X
TaxonomyPrivate Vehicle
License Number
License Number State

VIII. Authorized Official

Name: GEORGE-ANN MARIE CARTER
Title or Position: CASE MANAGER/CARE COORDINATOR
Credential: CHW
Phone: 614-622-5155