Healthcare Provider Details

I. General information

NPI: 1992050009
Provider Name (Legal Business Name): NATIONWIDE CHILDREN'S HOSPITAL, INC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 07/16/2012
Last Update Date: 07/27/2012
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

399 E MAIN ST
COLUMBUS OH
43215-5384
US

IV. Provider business mailing address

255 E MAIN ST 3RD FLOOR
COLUMBUS OH
43215-5222
US

V. Phone/Fax

Practice location:
  • Phone: 614-355-8550
  • Fax: 614-355-8593
Mailing address:
  • Phone: 614-355-0511
  • Fax: 614-355-0509

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code251S00000X
TaxonomyCommunity/Behavioral Health Agency
License Number
License Number State
# 2
Primary TaxonomyN
Taxonomy Code261QM0801X
TaxonomyMental Health Clinic/Center (Including Community Mental Health Center)
License Number
License Number State
# 3
Primary TaxonomyN
Taxonomy Code261QM0855X
TaxonomyAdolescent and Children Mental Health Clinic/Center
License Number
License Number State

VIII. Authorized Official

Name: AILEEN P. HOFFMAN
Title or Position: BEHAVIORAL HEALTH OPERATIONS MANAGE
Credential:
Phone: 614-355-0511