Healthcare Provider Details

I. General information

NPI: 1679235956
Provider Name (Legal Business Name): REFUGE, INC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 10/13/2021
Last Update Date: 10/13/2021
Certification Date: 10/13/2021
Deactivation Date:
Reactivation Date:

III. Provider practice location address

12 S TERRACE AVE
COLUMBUS OH
43204-3281
US

IV. Provider business mailing address

12 S TERRACE AVE
COLUMBUS OH
43204-3281
US

V. Phone/Fax

Practice location:
  • Phone: 614-991-0131
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code261QM0801X
TaxonomyMental Health Clinic/Center (Including Community Mental Health Center)
License Number
License Number State
# 2
Primary TaxonomyN
Taxonomy Code320800000X
TaxonomyMental Illness Community Based Residential Treatment Facility
License Number
License Number State

VIII. Authorized Official

Name: BENJAMIN B REYNOLDS
Title or Position: CFO
Credential:
Phone: 740-708-6440