Healthcare Provider Details

I. General information

NPI: 1235493990
Provider Name (Legal Business Name): MIFFLIN YOUTH GROUP
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 06/27/2012
Last Update Date: 06/27/2012
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1688 SCHROCK RD
COLUMBUS OH
43229-1500
US

IV. Provider business mailing address

1688 SCHROCK RD
COLUMBUS OH
43229-1500
US

V. Phone/Fax

Practice location:
  • Phone: 614-456-6029
  • Fax:
Mailing address:
  • Phone: 614-456-6029
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code273R00000X
TaxonomyPsychiatric Hospital Unit
License Number35076471
License Number StateOH

VIII. Authorized Official

Name: MRS. LIZA R HOPKINS
Title or Position: EXECUTIVE DIRECTOR
Credential:
Phone: 614-456-6029