MEDICARE: ENTWINED LIGHT BEHAVIOR HEALTH COMMUNITY LLC

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy
1	251B00000X	Case Management Agency
2	261QM0801X	Mental Health Clinic/Center (Including Community Mental Health Center)
3	261QR0405X	Substance Use Disorder Rehabilitation Clinic/Center
4	251S00000X	Community/Behavioral Health Agency

General Provider Information

NPI Number	:	1154289098
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	ENTWINED LIGHT BEHAVIOR HEALTH COMMUNITY LLC

Provider Business Mailing Address
First Line	:	2323 LAKE CLUB DR STE 201
Second Line	:
City	:	COLUMBUS
State	:	OH
Zip	:	43232-3101
Country	:	US
Telephone Number	:	380-249-4316
Fax Number	:

Provider Business Practice Location Address
First Line	:	2323 LAKE CLUB DR STE 201
Second Line	:
City	:	COLUMBUS
State	:	OH
Zip	:	43232-3101
Country	:	US
Telephone Number	:	380-249-4316
Fax Number	:

Authorized Official
Title or Position	:	CEO
Name	:	BRIANNA SIMPSON
Credential	:
Telephone Number	:	380-249-4316

Provider Enumeration Date	:	01/12/2026
Last Update Date	:	01/12/2026

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