Healthcare Provider Details

I. General information

NPI: 1992597033
Provider Name (Legal Business Name): FRUITFUL TREES
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 05/22/2025
Last Update Date: 05/29/2025
Certification Date: 05/29/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

81 PRICE RD
GAHANNA OH
43230-3303
US

IV. Provider business mailing address

2847 KEANNEN ST
BLACKLICK OH
43004-6027
US

V. Phone/Fax

Practice location:
  • Phone: 614-783-1435
  • Fax:
Mailing address:
  • Phone: 614-783-1435
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code261QM0855X
TaxonomyAdolescent and Children Mental Health Clinic/Center
License Number
License Number State
# 2
Primary TaxonomyN
Taxonomy Code251E00000X
TaxonomyHome Health Agency
License Number
License Number State
# 3
Primary TaxonomyY
Taxonomy Code251S00000X
TaxonomyCommunity/Behavioral Health Agency
License Number
License Number State

VIII. Authorized Official

Name: MISS CHRISTIAN OWENS
Title or Position: OWENER
Credential:
Phone: 614-783-1435