Healthcare Provider Details

I. General information

NPI: 1255408316
Provider Name (Legal Business Name): VIAQUEST HEALTHCARE
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 11/30/2006
Last Update Date: 03/12/2008
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

6493 ROSELAWN AVE
REYNOLDSBURG OH
43068-2813
US

IV. Provider business mailing address

525 METRO PL N SUITE 300
DUBLIN OH
43017-5342
US

V. Phone/Fax

Practice location:
  • Phone: 614-501-8614
  • Fax: 614-501-8717
Mailing address:
  • Phone: 614-889-5837
  • Fax: 614-889-5847

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code320900000X
TaxonomyIntellectual and/or Developmental Disabilities Community Based Residential Treatment Facility
License Number2514106
License Number StateOH

VIII. Authorized Official

Name: SARA SELBE
Title or Position: VP OF OPERATIONS
Credential:
Phone: 614-889-5837