MEDICARE: OHIO YOUTH ADVOCATE PROGRAM

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	251K00000X	Public Health or Welfare Agency	353	OH
2	251K00000X	Public Health or Welfare Agency	10709	OH

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	:	1326002122
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	OHIO YOUTH ADVOCATE PROGRAM

Provider Business Mailing Address
First Line	:	6233 RIVERSIDE DR
Second Line	:
City	:	DUBLIN
State	:	OH
Zip	:	43017-5069
Country	:	US
Telephone Number	:	614-717-8000
Fax Number	:	614-717-8020

Provider Business Practice Location Address
First Line	:	1445 SUMMIT ST
Second Line	:
City	:	COLUMBUS
State	:	OH
Zip	:	43201-2105
Country	:	US
Telephone Number	:	614-523-1001
Fax Number	:	614-583-1003

Authorized Official
Title or Position	:	EXECUTIVE DIRECTOR
Name	:	MRS. JOAN M WILSON
Credential	:
Telephone Number	:	614-921-2111

Provider Enumeration Date	:	04/17/2006
Last Update Date	:	08/22/2020

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