Healthcare Provider Details

I. General information

NPI: 1891492419
Provider Name (Legal Business Name): INTEGRATED LINK SUPPORTED SERVICES
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 02/14/2023
Last Update Date: 02/14/2023
Certification Date: 02/14/2023
Deactivation Date:
Reactivation Date:

III. Provider practice location address

3848 BUFFLEHEAD DR
COLUMBUS OH
43230-1814
US

IV. Provider business mailing address

2020 BRICE RD # 235
REYNOLDSBURG OH
43068-3428
US

V. Phone/Fax

Practice location:
  • Phone: 614-648-3119
  • Fax:
Mailing address:
  • Phone: 614-648-3119
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code3104A0630X
TaxonomyAssisted Living Facility (Behavioral Disturbances)
License Number
License Number StateNULL
# 2
Primary TaxonomyN
Taxonomy Code385HR2060X
TaxonomyChild Intellectual and/or Developmental Disabilities Respite Care
License Number
License Number StateNULL
# 3
Primary TaxonomyN
Taxonomy Code251S00000X
TaxonomyCommunity/Behavioral Health Agency
License Number
License Number StateNULL

VIII. Authorized Official

Name: MR. EDWARD TURAY
Title or Position: CEO
Credential:
Phone: 614-648-3119