MEDICARE: INSTITUTE OF POSITIVE CHANGE, LLC

Medicare Provider Information

Scope of Practice

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

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	104100000X	Social Worker

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program

General Provider Information

NPI Number	:	1164069175
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	INSTITUTE OF POSITIVE CHANGE, LLC

Provider Business Mailing Address
First Line	:	PO BOX 83058
Second Line	:
City	:	COLUMBUS
State	:	OH
Zip	:	43203-0058
Country	:	US
Telephone Number	:	614-668-8411
Fax Number	:	614-824-3687

Provider Business Practice Location Address
First Line	:	223 MAYFAIR BLVD APT D
Second Line	:
City	:	COLUMBUS
State	:	OH
Zip	:	43213-2212
Country	:	US
Telephone Number	:	614-668-8411
Fax Number	:

Authorized Official
Title or Position	:	DIRECTOR
Name	:	ALLEN HUFF
Credential	:
Telephone Number	:	614-668-8411

Provider Enumeration Date	:	12/09/2019
Last Update Date	:	12/09/2019

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