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General NPI Number Information
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NPI Number | 1891056479
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Entity Type | Organization
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Legal Business Name | CENTRAL OHIO MENTAL HEALTH
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Dates
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Enumeration Date | 05/31/2012
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Last Update Date | 05/31/2012
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Provider Practice Location Address
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Address Line | 824 BOWTOWN RD
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City | DELAWARE
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State | OH
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Zip | 43015-9661
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Country | US
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Telephone | 740-369-7688
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Fax | 740-363-6415
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Provider Business Mailing Address
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Address Line | 824 BOWTOWN RD
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City | DELAWARE
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State | OH
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Zip | 43015-9661
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Country | US
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Telephone |
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Fax |
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Authorized Official
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Title or Position | CREDENTIALING SPECIALIST
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Name | DEBRA M DORNAN
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Credential |
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Telephone | 740-368-7834
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 251B00000X
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Taxonomy Name | Case Management Agency
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License Number | S120045
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License Number State | OH
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