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General NPI Number Information
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NPI Number | 1518379296
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Entity Type | Organization
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Legal Business Name | OHIO DEPARTMENT OF REHABILITATION AND CORRECTIONS
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Dates
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Enumeration Date | 05/29/2014
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Last Update Date | 05/29/2014
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Provider Practice Location Address
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Address Line | 770 W BROAD ST
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City | COLUMBUS
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State | OH
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Zip | 43222-1419
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Country | US
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Telephone | 614-752-1164
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Fax |
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Provider Business Mailing Address
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Address Line | 770 WEST BROAD STREET
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City | COLUMBUS
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State | OH
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Zip | 43222
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Country | US
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Telephone | 740-852-2454
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Fax | 740-845-3373
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Authorized Official
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Title or Position | DIRECTOR / ODRC
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Name | MR. GARY C MOHR
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Credential |
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Telephone | 614-752-1164
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 251S00000X
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Taxonomy Name | Community/Behavioral Health Agency
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License Number | 001345
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License Number State | OH
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