Healthcare Provider Details

I. General information

NPI: 1720011828
Provider Name (Legal Business Name): PARKSIDE BEHAVIORAL HEALTHCARE ACQUISITION INC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 07/09/2006
Last Update Date: 01/29/2025
Certification Date: 01/29/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

349 OLDE RIDENOUR RD
COLUMBUS OH
43230-2528
US

IV. Provider business mailing address

7074 GROVE RD STE 129
SPRING HILL FL
34609-8658
US

V. Phone/Fax

Practice location:
  • Phone: 614-471-2552
  • Fax: 614-471-0167
Mailing address:
  • Phone: 523-597-5075
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code283Q00000X
TaxonomyPsychiatric Hospital
License Number
License Number StateOH

VIII. Authorized Official

Name: MS. TRACY ROBERTS
Title or Position: CORPORATE DIRECTOR REVENUE CYCLE
Credential:
Phone: 423-895-0084