Healthcare Provider Details

I. General information

NPI: 1780548602
Provider Name (Legal Business Name): CASE KEGLEY
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 12/15/2025
Last Update Date: 12/15/2025
Certification Date: 12/15/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

6020 GROVEPORT RD
GROVEPORT OH
43125-1005
US

IV. Provider business mailing address

211 S 5TH ST
COLUMBUS OH
43215-5203
US

V. Phone/Fax

Practice location:
  • Phone: 614-567-6274
  • Fax: 855-604-0927
Mailing address:
  • Phone: 614-567-6274
  • Fax: 855-604-0927

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code171M00000X
TaxonomyCase Manager/Care Coordinator
License Number
License Number State
# 2
Primary TaxonomyY
Taxonomy Code101YA0400X
TaxonomyAddiction (Substance Use Disorder) Counselor
License Number
License Number State

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: