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General NPI Number Information
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NPI Number | 1336978287
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Entity Type | Organization
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Legal Business Name | JADED UNRPOTECTED VOLATILE YOUTH SERVICES, LLC
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Dates
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Enumeration Date | 07/30/2024
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Last Update Date | 11/13/2024
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Provider Practice Location Address
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Address Line | 2650 W BROAD ST
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City | COLUMBUS
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State | OH
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Zip | 43204-3329
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Country | US
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Telephone | 614-290-2637
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Fax |
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Provider Business Mailing Address
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Address Line | 7850 PETER HOOVER RD
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City | NEW ALBANY
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State | OH
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Zip | 43054-9723
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Country | US
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Telephone | 614-290-2637
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Fax |
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Authorized Official
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Title or Position | CHIEF OPERATIONS OFFICER
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Name | MRS. NATASHA TURNER
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Credential |
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Telephone | 614-632-0076
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 225800000X
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Taxonomy Name | Recreation Therapist
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License Number |
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License Number State |
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Taxonomy #2
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Taxonomy Code | 251S00000X
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Taxonomy Name | Community/Behavioral Health Agency
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License Number |
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License Number State |
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