Healthcare Provider Details

I. General information

NPI: 1639060510
Provider Name (Legal Business Name): JANE'S HOUSE
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 07/10/2025
Last Update Date: 07/10/2025
Certification Date: 07/10/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

3519 GERBERT RD
COLUMBUS OH
43224-3408
US

IV. Provider business mailing address

3519 GERBERT RD
COLUMBUS OH
43224-3408
US

V. Phone/Fax

Practice location:
  • Phone: 614-593-0690
  • Fax:
Mailing address:
  • Phone: 614-593-0690
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code261Q00000X
TaxonomyClinic/Center
License Number
License Number StateNULL
# 2
Primary TaxonomyY
Taxonomy Code261QM0801X
TaxonomyMental Health Clinic/Center (Including Community Mental Health Center)
License Number
License Number StateNULL
# 3
Primary TaxonomyN
Taxonomy Code261QP0905X
TaxonomyState or Local Public Health Clinic/Center
License Number
License Number StateNULL
# 4
Primary TaxonomyN
Taxonomy Code251S00000X
TaxonomyCommunity/Behavioral Health Agency
License Number
License Number StateNULL

VIII. Authorized Official

Name: SONYA TRENT-PELLOM
Title or Position: OWNER/CEO
Credential:
Phone: 614-593-0690