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General NPI Number Information
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NPI Number | 1962201590
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Entity Type | Organization
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Legal Business Name | JEREMIAHS CORNER
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Dates
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Enumeration Date | 03/07/2025
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Last Update Date | 03/07/2025
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Provider Practice Location Address
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Address Line | 170 NORTHWOODS BLVD STE 210
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City | COLUMBUS
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State | OH
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Zip | 43235-4711
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Country | US
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Telephone | 614-721-4422
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Fax |
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Provider Business Mailing Address
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Address Line | 170 NORTHWOODS BLVD STE 210
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City | COLUMBUS
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State | OH
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Zip | 43235-4711
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Country | US
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Telephone | 614-721-4422
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Fax |
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Authorized Official
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Title or Position | CEO
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Name | JESSICA BENNETT
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Credential | M.ED.
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Telephone | 614-721-4422
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 252Y00000X
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Taxonomy Name | Early Intervention Provider Agency
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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 | 261Q00000X
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Taxonomy Name | Clinic/Center
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License Number |
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License Number State |
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Taxonomy #3
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Taxonomy Code | 261QM1300X
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Taxonomy Name | Multi-Specialty Clinic/Center
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License Number |
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License Number State |
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Taxonomy #4
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Taxonomy Code | 261QX0100X
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Taxonomy Name | Occupational Medicine Clinic/Center
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License Number |
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License Number State |
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Taxonomy #5
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Taxonomy Code | 385HR2060X
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Taxonomy Name | Child Intellectual and/or Developmental Disabilities Respite Care
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License Number |
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License Number State |
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Taxonomy #6
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Taxonomy Code | 385HR2065X
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Taxonomy Name | Child Physical Disabilities Respite Care
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License Number |
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License Number State |
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Taxonomy #7
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Taxonomy Code | 261QD1600X
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Taxonomy Name | Developmental Disabilities Clinic/Center
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License Number |
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License Number State |
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