MEDICARE: EMMYS HOUSE

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	101Y00000X	Counselor
2	104100000X	Social Worker

General Provider Information

NPI Number	:	1225419864
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	EMMYS HOUSE

Provider Business Mailing Address
First Line	:	PO BOX 217
Second Line	:
City	:	LEWIS CENTER
State	:	OH
Zip	:	43035-0217
Country	:	US
Telephone Number	:
Fax Number	:

Provider Business Practice Location Address
First Line	:	1338 MAETZEL DR
Second Line	:
City	:	COLUMBUS
State	:	OH
Zip	:	43227-1333
Country	:	US
Telephone Number	:	614-632-7237
Fax Number	:

Authorized Official
Title or Position	:	CEO
Name	:	MRS. KEYONA HARPER
Credential	:
Telephone Number	:	614-378-5198

Provider Enumeration Date	:	06/09/2015
Last Update Date	:	06/09/2015

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Directions to “EMMYS HOUSE ” Practice Location

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