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General NPI Number Information
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NPI Number | 1588104574
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Entity Type | Organization
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Legal Business Name | OHIO MENTOR, INC.
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Dates
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Enumeration Date | 02/24/2017
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Last Update Date | 02/24/2017
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Provider Practice Location Address
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Address Line | 5655 N HIGH ST
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City | WORTHINGTON
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State | OH
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Zip | 43085-3948
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Country | US
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Telephone | 614-885-0920
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Fax |
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Provider Business Mailing Address
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Address Line | 5655 N HIGH ST
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City | WORTHINGTON
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State | OH
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Zip | 43085-3948
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Country | US
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Telephone | 614-885-0920
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Fax |
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Authorized Official
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Title or Position | AREA MANAGER
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Name | ANGELO BONSUTTO
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Credential |
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Telephone | 330-957-2735
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 253J00000X
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Taxonomy Name | Foster Care Agency
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License Number | 010528
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License Number State | OH
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