Healthcare Provider Details

I. General information

NPI: 1609834712
Provider Name (Legal Business Name): ST VINCENT FAMILY CENTERS
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 05/01/2006
Last Update Date: 03/03/2017
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1490 E MAIN ST
COLUMBUS OH
43205-2140
US

IV. Provider business mailing address

1490 E MAIN ST
COLUMBUS OH
43205-2140
US

V. Phone/Fax

Practice location:
  • Phone: 614-252-0731
  • Fax: 614-252-8468
Mailing address:
  • Phone: 614-252-0731
  • Fax: 614-252-8468

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code261QM0855X
TaxonomyAdolescent and Children Mental Health Clinic/Center
License Number
License Number StateOH
# 2
Primary TaxonomyN
Taxonomy Code323P00000X
TaxonomyPsychiatric Residential Treatment Facility
License Number
License Number StateOH

VIII. Authorized Official

Name: SUSAN LEWIS KAYLOR
Title or Position: PRESIDENT/CEO
Credential:
Phone: 614-252-0731