Healthcare Provider Details

I. General information

NPI: 1881290831
Provider Name (Legal Business Name): TOMIKA GORDON
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 12/07/2020
Last Update Date: 11/24/2025
Certification Date: 11/24/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2244 S HAMILTON RD STE 101C
COLUMBUS OH
43232-4390
US

IV. Provider business mailing address

2244 S HAMILTON RD STE 101C
COLUMBUS OH
43232-4390
US

V. Phone/Fax

Practice location:
  • Phone: 855-519-2787
  • Fax: 614-868-1688
Mailing address:
  • Phone: 855-519-2787
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code3104A0625X
TaxonomyAssisted Living Facility (Mental Illness)
License Number
License Number StateNULL
# 2
Primary TaxonomyY
Taxonomy Code324500000X
TaxonomySubstance Abuse Rehabilitation Facility
License Number
License Number StateNULL
# 3
Primary TaxonomyN
Taxonomy Code171M00000X
TaxonomyCase Manager/Care Coordinator
License Number
License Number StateNULL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: