Healthcare Provider Details

I. General information

NPI: 1780273433
Provider Name (Legal Business Name): VERTAVA HEALTH OUTPATIENT OHIO LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 01/15/2021
Last Update Date: 09/14/2021
Certification Date: 09/14/2021
Deactivation Date:
Reactivation Date:

III. Provider practice location address

110 POLARIS PKWY STE 210
WESTERVILLE OH
43082-8070
US

IV. Provider business mailing address

PO BOX 90368
NASHVILLE TN
37209-0368
US

V. Phone/Fax

Practice location:
  • Phone: 614-964-1622
  • Fax: 614-964-1805
Mailing address:
  • Phone: 615-921-4447
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code261QM0801X
TaxonomyMental Health Clinic/Center (Including Community Mental Health Center)
License Number
License Number State
# 2
Primary TaxonomyY
Taxonomy Code261QR0405X
TaxonomySubstance Use Disorder Rehabilitation Clinic/Center
License Number
License Number State

VIII. Authorized Official

Name: LEIGH ANN THOMPSON
Title or Position: SR DIRECTOR
Credential:
Phone: 615-921-4447