Healthcare Provider Details

I. General information

NPI: 1063479079
Provider Name (Legal Business Name): BEHAVIORAL HEALTHCARE PARTNERS OF CENTRAL OHIO INC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 04/26/2006
Last Update Date: 05/09/2017
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

65 MESSIMER DR
NEWARK OH
43055-1874
US

IV. Provider business mailing address

65 MESSIMER DR
NEWARK OH
43055-1874
US

V. Phone/Fax

Practice location:
  • Phone: 740-522-8477
  • Fax: 740-788-3424
Mailing address:
  • Phone: 740-522-8477
  • Fax: 740-788-3424

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code2083X0100X
TaxonomyOccupational Medicine Physician
License Number35.037464
License Number StateOH
# 2
Primary TaxonomyY
Taxonomy Code261QM0801X
TaxonomyMental Health Clinic/Center (Including Community Mental Health Center)
License Number
License Number State

VIII. Authorized Official

Name: MRS. LEE RENNER
Title or Position: BILLING SUPERVISOR
Credential:
Phone: 740-788-0236