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General NPI Number Information
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NPI Number | 1720695943
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Entity Type | Organization
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Legal Business Name | ELEVEN 11 BEHAVIORAL SOLUTIONS
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Dates
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Enumeration Date | 09/30/2020
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Last Update Date | 05/25/2021
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Provider Practice Location Address
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Address Line | 2993 SAND DOLLAR DR
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City | COLUMBUS
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State | OH
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Zip | 43232-7724
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Country | US
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Telephone | 216-870-6089
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Fax |
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Provider Business Mailing Address
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Address Line | 2993 SAND DOLLAR DR
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City | COLUMBUS
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State | OH
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Zip | 43232-7724
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Country | US
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Telephone | 216-870-6089
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Fax |
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Authorized Official
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Title or Position | OWNER
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Name | MRS. MARKITA CUMBERLANDER
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Credential | M.ED., BCBA, COBA
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Telephone | 216-870-6089
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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 |
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License Number State |
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