=====================================================
General NPI Number Information
=====================================================
NPI Number | 1083688097
-----------------------------------------------------
Entity Type | Organization
-----------------------------------------------------
Legal Business Name | STATE OF OHIO OFFICE OF BUDGET AND MANAGEMENT STATE ACCOUNTING
-----------------------------------------------------
=====================================================
Dates
=====================================================
Enumeration Date | 02/15/2006
-----------------------------------------------------
Last Update Date | 02/17/2015
-----------------------------------------------------
=====================================================
Provider Practice Location Address
=====================================================
Address Line | 930 S DETROIT AVE
-----------------------------------------------------
City | TOLEDO
-----------------------------------------------------
State | OH
-----------------------------------------------------
Zip | 43614-2701
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 419-381-1881
-----------------------------------------------------
Fax | 419-389-1361
-----------------------------------------------------
=====================================================
Provider Business Mailing Address
=====================================================
Address Line | 30 E BROAD ST 11TH FL, ATTN:BETTY TAYLOR
-----------------------------------------------------
City | COLUMBUS
-----------------------------------------------------
State | OH
-----------------------------------------------------
Zip | 43215-3414
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 614-728-2546
-----------------------------------------------------
Fax | 614-644-9116
-----------------------------------------------------
=====================================================
Authorized Official
=====================================================
Title or Position | DEPUTY DIRECTOR
-----------------------------------------------------
Name | MR. DAVID COLLETTI
-----------------------------------------------------
Credential |
-----------------------------------------------------
Telephone | 614-452-4343
-----------------------------------------------------
=====================================================
Scope of Practice (Provider's specialty)
=====================================================
Taxonomy #1
-----------------------------------------------------
Taxonomy Code | 283Q00000X
-----------------------------------------------------
Taxonomy Name | Psychiatric Hospital
-----------------------------------------------------
License Number | NA
-----------------------------------------------------
License Number State |
-----------------------------------------------------